PR-142 is a normal part of long-term care billing. When a Medicaid resident in a nursing home has income, the state sets a monthly amount the resident must pay toward care. Medicaid then pays the facility its rate minus that amount. The remit shows the difference with CARC 142 under group PR, which means it’s the patient’s share to collect. It isn’t a denial and it isn’t a write-off. (Primary source: X12 Claim Adjustment Reason Codes)
In brief: CARC 142 reads “Monthly Medicaid patient liability amount.” Match the amount to the state’s notice for that month, bill it to the resident or their representative, and fix the claim only if the amount on it was wrong.
Part of our denial codes library. Written by Manikandan J, CPC, CRCR, who has reconciled Medicaid remits for skilled nursing and long-term care billing teams. Published 21 October 2026. Last updated: 21 October 2026. Code wording quoted word for word from X12.
Reason code 142 in the X12 list
| Field | X12 text |
|---|---|
| Code | 142 |
| Description | “Monthly Medicaid patient liability amount.” |
| Start | 06/30/2000 |
| Last modified | 09/30/2007 |
Source: X12 Claim Adjustment Reason Codes, checked 21 October 2026.
Where the patient liability amount comes from
Patient liability is the part of a Medicaid resident’s monthly income that must go toward the cost of nursing facility care. States often call it the patient pay amount or share of cost. The post-eligibility treatment of income is the federal process that sets it, found in 42 CFR 435.725. It starts with the resident’s income. Then it takes out allowed items, such as a personal needs allowance and health insurance premiums. What’s left is the monthly amount.
A liability notice is the letter or record where the state tells the facility the amount. It may come by mail or through the state’s online system. It can change when income changes, such as a yearly Social Security increase.
Example scenario (fictional names), part 1
PR-142 Denial Example: What Happened
Rebecca Holloway is the business office manager at Willow Creek Care Center. A long-term Medicaid resident’s March claim went to Prairie State Medicaid Plan, a fictional managed Medicaid plan. It billed revenue code 0120 for 31 room and board days, with value code 31 showing the resident’s patient liability.
The remit cut the payment with CAS*PR*142, but the amount was higher than Rebecca’s ledger. It also carried remark LQ*HE*N58, “Missing/incomplete/invalid patient liability amount.”
Which number was right, the plan’s or the facility’s? Keep reading, or jump to how the PR-142 denial was resolved.
How to work a PR-142 line
- Pull the state’s notice for that month. Match the liability on the remit to the notice, not to last month’s ledger.
- Check the claim’s value code. On the UB-04, many states expect the liability in a value code field, such as value code 31. Your state manual has the exact rule.
- Bill the resident or representative. Send a statement for the PR-142 amount, the same as any patient share.
- Prorate partial months. For example, if the resident was admitted, discharged or died mid-month, follow the state’s proration rule.
- Correct the claim if your amount was wrong. Send a replacement claim with the right value code amount.
- Ask the state to fix its file if the notice was wrong. The plan can only use what the state sends.
Example scenario (fictional names), part 2
How the PR-142 Denial Was Resolved
Rebecca checked the state’s eligibility portal. The resident’s Social Security payment had gone up in January, and a new liability notice had been issued. The facility had never updated its ledger.
Fix: she sent a replacement claim, frequency code 7, with the new amount in value code 31. She updated the ledger for January through March and billed the resident’s daughter, who held power of attorney, for the difference.
Outcome: the replacement claim processed with no N58 remark. Willow Creek now checks the state portal every January.
Names and details are illustrative; no real patient data.
CMS-1500 not shown: nursing facility room and board and value code 31 exist only on the UB-04.
- FL 39-41: value code 31 (patient liability) changed to the amount on the new state notice (amounts are placeholders).
- FL 4 + FL 64: replacement claim, frequency digit 7 (type of bill 0217 for a nursing facility), with the original claim number.
- FL 42-46: revenue code 0120 for 31 days is unchanged.
Remark codes you may see with CARC 142
| RARC | X12 wording |
|---|---|
| N58 | “Missing/incomplete/invalid patient liability amount.” |
| N23 | “Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.” |
See the full X12 RARC list.
Worked example (illustrative)
Consider a resident with a monthly liability set by the state who goes to the hospital for ten days in the middle of the month. The facility bills Medicaid only for the days in the building, plus any covered bed-hold days. The liability still applies, but how it splits across the facility and the hospital stay depends on the state’s rules. The business office checks the state manual before billing the family.
Mistakes that cause PR-142 problems
| Mistake | What happens |
|---|---|
| Using last year’s amount | The plan’s cut and your bill won’t match |
| Writing PR-142 off | Lost revenue and an audit risk |
| Billing the full amount for a partial month | Overcharging the resident |
| Leaving out the value code | N58 or a delayed claim |
Related codes
Recap
PR-142 is the resident’s monthly Medicaid patient liability. Match it to the state’s current notice, bill it to the resident or representative, and correct the claim or the state’s file when the numbers don’t match. Check for new notices every time income changes.
FAQ
What does PR-142 mean on a Medicaid remit?
Medicaid reduced the payment by the resident’s monthly patient liability. It reads “Monthly Medicaid patient liability amount.”
Can I bill the resident for PR-142?
Yes. The PR group makes it the patient’s share. Bill the resident or their representative.
Is CARC 142 a denial?
No. It’s a cost-sharing adjustment set by the state.
Why is the PR-142 amount different from my ledger?
The state may have issued a new notice, often after an income change. Check the current notice.
What does N58 mean with reason code 142?
The patient liability amount on your claim was missing or didn’t match the plan’s file.
How do I bill patient liability for a partial month?
Follow your state’s proration rule for admission, discharge or death during the month.
Sources
How we checked: each code quote on this page was matched word for word with the X12 CARC and RARC lists on 21 October 2026.
- X12, Claim Adjustment Reason Codes (CARC 142, 1, 3, 45). Accessed 21 Oct 2026.
- X12, Remittance Advice Remark Codes (N58, N23). Accessed 21 Oct 2026.
- eCFR, 42 CFR 435.725, post-eligibility treatment of income. Accessed 21 Oct 2026.
Last updated: 21 October 2026 · Educational content; not legal advice.