PR-26 / PR-27: Service before coverage began, or after it ended
Triage: Recheck eligibility
By Dr. Daniel Turner, DC · Reviewed September 2, 2026
What does denial code PR-26 / PR-27 mean?
Twin codes for the two edges of a policy: 26 means the date of service came before the plan’s effective date, 27 means it came after termination.
What does PR-26 / PR-27 usually mean in a chiropractic office?
These cluster around January, when plans change, and around job changes. A patient hands over the new card in March for a plan effective February 1, and January’s visits billed to the new plan bounce with PR-26 while the old plan should have gotten them.
How do you fix a PR-26 / PR-27 denial?
- Pin down the effective and termination dates of both the old and new plans.
- Rebill each date of service to the plan that was actually active that day.
- If no plan covered the date, the balance is patient responsibility.
What this looks like in practice
A plan year changes January first. The office bills January visits to the new plan the patient mentioned, but the new plan’s effective date is February first, producing PR-26 denials. The old plan was active through January and would have paid, and still will if its filing window has not closed. The clock, not the coding, is the enemy.
How to stop it from happening again
- ✓Record effective and termination dates whenever eligibility returns them
- ✓Bill each date of service to the plan active on that day, splitting months when coverage changed mid stream
- ✓Move fast on boundary denials; the correct payer’s filing window has been running the whole time
How Cervica handles PR-26 / PR-27
Eligibility results record effective and term dates, and the worklist shows which plan was live on the denied date of service so rebills go to the right place the first time.
Related codes
Quick answers
What does denial code PR-26 / PR-27 mean?
Twin codes for the two edges of a policy: 26 means the date of service came before the plan’s effective date, 27 means it came after termination.
What does PR-26 / PR-27 usually mean in a chiropractic office?
These cluster around January, when plans change, and around job changes. A patient hands over the new card in March for a plan effective February 1, and January’s visits billed to the new plan bounce with PR-26 while the old plan should have gotten them.
How do you fix a PR-26 / PR-27 denial?
Pin down the effective and termination dates of both the old and new plans. Rebill each date of service to the plan that was actually active that day. If no plan covered the date, the balance is patient responsibility.
General information for billing teams, not legal or payer specific advice. CARC definitions belong to X12; payer policies vary and control. Verify against the payer contract before acting on any individual claim.