How do I fix or resolve code 2?

Verify the patient's coinsurance percentage from the eligibility/benefits response (271 transaction) or the payer's member portal to confirm the applied amount is correct. Cross-check the coinsurance calculation against the allowed amount on the ERA to ensure the payer applied the correct percentage. Bill the patient for the coinsurance amount with a statement that clearly shows the payer's payment, the allowed amount, and the patient responsibility. If the patient has secondary insurance, submit the claim to the secondary payer with the primary EOB attached for coordination of benefits. If the patient disputes the coinsurance or the amount appears incorrect, request a claim reconsideration from the payer with supporting documentation.

2Adjustment CodeGeneral Adjustment

Code 2

Problem Description

Coinsurance Amount

Root Cause

The coinsurance amount has been applied to this claim. After the deductible is met, the payer adjudicates the claim and applies the patient's coinsurance percentage (commonly 10%, 20%, or 30%) as a Patient Responsibility adjustment. The patient owes this coinsurance amount to the provider. This is a standard cost-sharing mechanism in most commercial health plans and Medicare. The adjustment is informational — the claim is not denied, but the patient balance must be collected.

Resolution Steps

1Verify the patient's coinsurance percentage from the eligibility/benefits response (271 transaction) or the payer's member portal to confirm the applied amount is correct.
2Cross-check the coinsurance calculation against the allowed amount on the ERA to ensure the payer applied the correct percentage.
3Bill the patient for the coinsurance amount with a statement that clearly shows the payer's payment, the allowed amount, and the patient responsibility.
4If the patient has secondary insurance, submit the claim to the secondary payer with the primary EOB attached for coordination of benefits.
5If the patient disputes the coinsurance or the amount appears incorrect, request a claim reconsideration from the payer with supporting documentation.

EHR Documentation Note

Claim adjusted PR-2 — coinsurance applied; verified coinsurance percentage, billed patient for coinsurance amount, and updated account balance.

Preventative Action

Verify coinsurance rates during pre-visit eligibility checks and provide patients with estimated cost-sharing amounts before service to set payment expectations.

Related Codes in General Adjustment

Deductible 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.