PR 179 denial code
Claim adjustment reason code 179. Often reported as PR 179 or CO 179.
Waiting period not met
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 .
What 179 means
The patient had not completed a waiting period the plan requires before this benefit becomes available.
Some plans make members wait a set time after enrollment before certain benefits apply. This code means the service fell inside that waiting period.
The remittance may include a policy reference that explains the rule. Check the enrollment date and the waiting period for this benefit.
Group codes seen with 179
On a remittance, 179 comes after a group code. These are the ones it is most often reported with:
- PR 179 (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 179 (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 service was given before the plan's waiting period for that benefit ended.
- The enrollment date on file is later than the patient believes.
- The plan treats the condition as subject to a waiting period.
What to do next
- Confirm the enrollment date and the waiting period for the benefit with the payer.
- Correct the record and resubmit if the enrollment date is wrong.
- Check for other coverage that could pay during the waiting period.
Related codes
Source
Official wording: X12 Claim Adjustment Reason Codes list. The explanation on this page is our own plain-English wording, not the X12 text.
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