27: Expenses incurred after coverage terminated.
The date of service falls after the patient's insurance coverage ended, so the payer will not pay for it under that policy.
What the group code means
- PR
- Patient Responsibility. The amount may be billed to the patient.
Why it fires
- The patient's coverage was terminated, such as from job loss or a plan change, before the date of service
- Eligibility was checked too far in advance and the termination happened afterward
- A retroactive termination was applied by the payer after the service was already rendered
Corrective actions, ranked
- 1
Verify the termination date
Confirm the exact termination date on the payer's eligibility system. Effective dates can be retroactive.
- 2
Identify new coverage
Ask the patient for updated insurance information effective on the date of service and rebill the correct payer.
- 3
Bill the patient if uninsured
If no other coverage exists for that date, move the balance to patient responsibility per your self-pay policy.
Is it worth appealing
Appeal only if you can show the termination date is wrong or coverage was reinstated retroactively. A confirmed termination before the date of service is not appealable.
Retrieved 2026-07-18.
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DenialPath provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.