Patient liability routing

Outcome

You understand how the platform routes PR-1 / PR-2 / PR-3 (and patient-side balances after secondary) to the patient AR ledger, when to expect a statement, and how to spot misrouted balances.

Prerequisites

Scope	What it lets you do
billing.receivable.read	View incoming PR rows
billing.payment.read	View patient payments
billing.statements.read	View patient statements

How patient AR is created

PR-1/2/3 rows route automatically on Post. The platform writes a payment_application row of type PATIENT_AR against the claim, and the corresponding amount appears in the member's patient AR ledger.

Where to see patient AR

Location	What it shows
Member detail → AR tab	Full patient AR ledger for the member.
/patient-billing/aging	Patient AR aging across all members.
Statements view	Pre-statement aggregates.
Dashboard Patient AR widget	Total patient AR + trend.

Reading the ledger

A member's AR tab shows entries:

Column	Meaning
Date	When the entry posted.
Source	Claim ID + line.
Type	PR-1, PR-2, PR-3, WRITEOFF, PAYMENT, REFUND.
Amount	Positive = owed; negative = paid / written off.
Balance	Running balance.
Statement	Which statement (if any) this entry was on.

Secondary patient liability

After a primary 835 posts, the secondary build picks up. After the secondary 835 posts, residual liability routes per the secondary's CAS:

Pattern	Where it goes
PR-* from secondary	Patient AR (normal).
OA-23 from secondary	Informational (impact-of-prior-payer).
Net unpaid after secondary	Patient AR balance.

Tertiary follows the same shape; whatever is unpaid after tertiary is the patient's.

When PR routes look wrong

Pattern	Likely cause
Member has zero balance but expected PR-1	Deductible already met for the year; payer paid in full.
Member has high PR-2 but expected low	Out-of-network coinsurance; verify network status.
Patient AR + payer paid ≠ billed	A CO-45 or other contractual is in play; see the line drill.
Patient AR posts on a claim before the secondary's 835 arrives	The platform routes per-line; secondary may still cover. Wait for the secondary 835.

What patient AR doesn't include

These do not land in patient AR:

• CO-45 fee-schedule diff — contractual write-off, not patient.
• CO-* other contractual codes — same.
• Bundled service reductions (CO-97) — contractual.
• Charges that haven't billed yet — patient AR is post-adjudication.

Validation

Check	Expected
PR-* rows post to patient AR on receivable post	Yes.
Member AR balance updates immediately	Yes.
Patient AR ages from posting date	Yes (configurable).
Statement eligibility flips when balance > $0	Yes (cadence-dependent).

Troubleshooting

Symptom	Cause	Fix
PR-1 didn't route	Receivable not posted yet	Confirm receivable status.
Balance shows on wrong member	835 line matched to the wrong claim	Reverse the match; redo manually.
Patient balance increased after a refund	Refund processed against the wrong account	Audit log will show; reverse with reason.
Net liability negative	Patient overpaid; refund pending	Issue refund per 4.8 — Manual posting.

Where to next

• 7.2 — Secondary balance after primary for COB-driven nuances.
• 7.3 — Statements for the patient-facing flow.