PR-192: Non-Standard COB Adjustment Code

What Does PR-192 Mean?

PR-192 is uncommon and appears when the non-standard COB adjustment identifies an amount that is the patient's responsibility but does not map to standard deductible, coinsurance, or copayment categories.

CARC 192 appears on your remittance when a payer uses a non-standard adjustment to communicate Coordination of Benefits information, typically in 837 transactions between payers. This code is specifically designed for situations where the primary payer made an adjustment that cannot be mapped to an existing standard CARC code for deductible, coinsurance, or co-payment — essentially a catch-all for COB adjustments that do not fit the normal categories.

This code behaves differently from most CARC codes because it is fundamentally informational rather than actionable. The primary payer is telling you (or the secondary payer) about an adjustment, but the adjustment itself may not represent a denial or a problem to fix. In practice, you will most commonly see CARC 192 when processing secondary claims — the primary payer's ERA includes this code to convey adjustment amounts that the secondary payer needs to know about for proper benefit coordination.

The key challenge with CARC 192 is interpretation. Because it is a non-standard catch-all, the specific meaning varies by payer. One payer may use it for a premium surcharge adjustment while another uses it for a plan-specific limitation that has no standard code equivalent. The ERA's accompanying RARC codes and any additional notes from the payer are critical for understanding what the adjustment actually represents and how to bill the secondary payer correctly.

How to Resolve

Review the primary payer's EOB for COB adjustment details, determine the correct secondary billing amount, and submit the secondary claim with accurate COB information.

1. Determine the patient responsibility Review the ERA and EOB to understand what the non-standard patient responsibility amount represents. Contact the payer for clarification if the basis is unclear.
2. Bill the patient Invoice the patient for the identified responsibility amount, with a clear explanation of the COB-related adjustment.

How to Prevent PR-192

• Verify COB details with all payers before service to estimate the patient's total out-of-pocket responsibility accurately
• Communicate with patients about how multiple insurance coverage affects their cost-sharing obligations

Also Filed As

The same CARC 192 may appear with different Group Codes:

Related Denial Codes