How do I fix or resolve code 1?

Verify the patient's deductible status on the payer's eligibility portal or via a 270/271 electronic eligibility transaction to confirm the remaining deductible amount. Check whether the deductible was already met through other claims and the payer's adjudication is outdated; if so, request a claim reconsideration with proof of prior deductible satisfaction. If the deductible is correctly applied, bill the patient for the deductible amount with a clear explanation of benefits statement showing the payer's adjudication. Set up a payment plan or offer financial assistance/charity care options if the patient is unable to pay the deductible upfront. If the patient disputes the deductible or has secondary insurance, coordinate benefits with the secondary payer and submit the claim with the primary EOB attached.

1Adjustment CodeGeneral Adjustment

Code 1

Problem Description

Deductible Amount

Root Cause

The deductible amount has been applied to this claim. This is a Patient Responsibility adjustment, not a denial — the payer has adjudicated the claim and determined that the patient's annual deductible has not yet been met, so the patient owes the deductible portion. The amount shown as the adjustment is the deductible applied; the patient is responsible for paying this amount to the provider. This is a standard cost-sharing mechanism in high-deductible health plans and traditional plans with deductible components.

Resolution Steps

1Verify the patient's deductible status on the payer's eligibility portal or via a 270/271 electronic eligibility transaction to confirm the remaining deductible amount.
2Check whether the deductible was already met through other claims and the payer's adjudication is outdated; if so, request a claim reconsideration with proof of prior deductible satisfaction.
3If the deductible is correctly applied, bill the patient for the deductible amount with a clear explanation of benefits statement showing the payer's adjudication.
4Set up a payment plan or offer financial assistance/charity care options if the patient is unable to pay the deductible upfront.
5If the patient disputes the deductible or has secondary insurance, coordinate benefits with the secondary payer and submit the claim with the primary EOB attached.

EHR Documentation Note

Claim adjusted PR-1 — deductible applied; verified patient deductible status, billed patient for deductible amount, and updated account balance.

Preventative Action

Verify patient deductible status during pre-visit eligibility checks and inform patients of their estimated out-of-pocket responsibility before the encounter to reduce bad debt.

Related Codes in General Adjustment

Coinsurance Amount

Co-payment Amount

The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

This directory provides reference information only and does not constitute official legal, medical, or financial billing advice. Always consult the payer's official remittance advice and current coding guidelines.