Denial code PR-27: Expenses incurred after coverage terminated
The patient’s coverage under this plan had ended before the date of service.
Expenses incurred after coverage terminated.
What PR-27 actually means
The payer’s eligibility file shows the member’s coverage terminated before the service was rendered. This is one of the most preventable denials in the revenue cycle: a real-time eligibility check on the day of service would have caught it before any cost was incurred. Once it lands, the work is to find the coverage that was actually in force, since the patient often has new insurance they simply did not report.
Why this denial happens
- The patient changed jobs or plans and presented an expired card.
- Premiums lapsed and the plan terminated retroactively.
- A dependent aged off the subscriber’s policy.
- Coverage ended between scheduling and the date of service.
How to resolve a PR-27 denial
- Contact the patient to identify the coverage in force on the date of service.
- Bill the correct payer if one exists and timely filing still allows it.
- If no coverage was in force, transfer to patient responsibility with an explanation of the termination.
- Check whether retroactive termination triggers a payer takeback on other paid claims for the same patient.
How to prevent it
- Run eligibility on the day of service, every time — not at scheduling, and not monthly.
- Flag patients whose coverage is set to terminate within the appointment window.
- Re-verify before every recurring or series visit rather than once at intake.
Frequently asked
What does denial code PR-27 mean?
The patient’s coverage under this plan had ended before the date of service. The X12 description reads: "Expenses incurred after coverage terminated."
How do I fix a PR-27 denial?
Contact the patient to identify the coverage in force on the date of service. Bill the correct payer if one exists and timely filing still allows it. If no coverage was in force, transfer to patient responsibility with an explanation of the termination. Check whether retroactive termination triggers a payer takeback on other paid claims for the same patient.
Can PR-27 be billed to the patient?
This code normally moves the balance to patient responsibility, subject to your payer agreement and to any advance notice of non-coverage requirements that apply.
Related denial codes
Related billing terms
See how much PR-27 is costing you
Upload your 835 remittance files and PayerVista groups every denial by reason code, payer, and dollar impact — so this code stops being a claim you happened to notice and becomes a number you can work.
General revenue-cycle guidance, not legal, coding, or payer-specific advice. Claim adjustment reason codes are maintained by X12 and are revised periodically; payer policy and your provider agreement govern in any specific case. Always read the remark codes transmitted with the denial — they frequently carry the detail this code does not.