Denial Code CO 31

Denial Code CO 31 also called as PR31 denial code – Patient Cannot be identified as our insured.

If insurances unable to identify the patient when provider billed the claim for reimbursement, then the insurance will deny the claim with denial code CO 31 / PR31 denial code. It means patient cannot be identified as our insured and claim cannot be reimbursed.

When you received this denial, it might be for the following reasons: Name discrepancies/Incorrect Subscriber ID/Incorrect Date of Birth or claim billed to wrong payer or claim mailing address.

Denial CO 31 / PR31 denial code solutions:

• First step is to check application for the insurance card copy of the patient. If we have found then check the eligibility and if patient policy is active for DOS, then update the correct patient details, insurance details and re bill the claim with correct information.
• If not found, then next step is to check to see the previous date of service whether claims submitted to same payer or any other different payers. And also, we should verify if we have received any payment for the previous date of service.
• If we have received payment from the same payer, then obtain the correct patient details from previous paid EOB. If paid EOB not available, then reach out claims representative with paid claim number to get the correct patient details. If found then update the correct details and rebill the claim.
• If previous DOS not found or not paid, then reach out claim representative department and search through patient Name date of birth or social security number?
• If representative found the patient, then next step is to check if they have received the claim billed?
• If DOS available, then get the claim status, claim number, Cal reference number and take the appropriate action.
• If rep unable to find the DOS for the patient, then obtain the correct patient member ID, Name, Date of birth also verify patient policy is active for date of service or not. If insurance is active for the DOS, then obtain patient effective and termination date. Also get the timely filing limit and claim mailing address to submit the claim.
• Get the Cal reference number?
• If we tried all the ways to search the patient, but still insurance is unable to identify the patient. Then we need to contact patient to get the correct payer details.

Note: When we get denial code CO 31 / PR31, we need work for all the date of service in the patient account. When you find the correct patient and insurance details, we need to check the patient account to see whether other date of service billed with correct details or if the insurance denied for the same reason denial code CO 31 / PR31 denial code. If they have billed with wrong details or insurance already denied with CO 31 / PR31, then please update the correct patient and insurance details and even rebill those claims for reimbursement.

Medical Billing Denials and actions – Top Denial codes Solutions (medicalbillingcycle.com)