PR 106 denial code

Claim adjustment reason code 106. Often reported as PR 106 or CO 106.

Patient payment option not in effect

Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated Nov 11, 2026.

What 106 means

The payer did not pay because the payment option or plan election the patient chose was not active.

The patient's plan offers a choice or election that controls how certain services are paid, and that election was not in force for this service. Examples include a benefit rider or plan option not selected for the period.

Often the patient can confirm their elections with the plan. The fix usually lies with the patient's enrollment rather than with the claim.

Group codes seen with 106

On a remittance, 106 comes after a group code. These are the ones it is most often reported with:

• PR 106 (Patient Responsibility): The amount is assigned to the patient. Deductibles, coinsurance and copays are the everyday examples. Whether you can collect it still depends on your contract and the patient's plan.
• CO 106 (Contractual Obligation): The provider's side of the ledger. The reduction comes from the payer contract or a rule the provider has to follow, and the patient normally cannot be billed for it.

The payer chooses the group code for each adjustment, so the same reason code can appear with another group code on your remittance. Read the two together. More about group codes.

Common causes

• The patient did not elect the benefit option that covers this service.
• The election had lapsed or had not yet started on the date of service.
• The payer's enrollment records do not show the option the patient believes they chose.

What to do next

1. Verify the patient's elections and effective dates with the payer.
2. Ask the patient to resolve enrollment issues with their plan or employer.
3. Resubmit or request reprocessing if the election is corrected back to the date of service.

Related codes

• 27 (reason code) Service after coverage ended
• 109 (reason code) Not covered by this payer, send elsewhere