PR 31 denial Code – Patient Can’t be identify Our insured

When it comes to Denial codes, they are the basic reason why your claim gets rejected. The phrase denial code is self explanatory and hence they are very much important to learn about. PR 31 denial code represent as patient can’t be identified as our insured. Meaning there is some issue in patient identification documents like SSN or insurance card, etc.

The concept of medical billing is divided into two broad categories- the denial code and the co code. If you are wondering what pr stands for, then it is precisely for “patient responsibility”.

Items under this category can be easily billed for those patients who are medically liable. The specific PR 31 Denial Code stands for all those billings which have been denied on the basis of identification issues.

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What Does the PR 31 Denial Code stand for?

One has to remember that the PR codes are exceptionally needed when it comes to medical billing. Having these codes affixed ensures that you know why your claim is being denied.

The PR 31 Denial Code specifically stands for those billings whose patient cannot be identified as an insurer with Medicare. This could also have a variety of clauses to it.

The first possibility is that the right Medicare number was not submitted. As a result, that did not match up with your credentials and the problem arises.

In that case, it is imperative that you check the number and other details well before sending it out for claims. The other possibility is that the claimant patient is not enrolled with Medicare.

Often there is a possibility that there might be mismatches and there is some kind of problem with the paperwork. Moreover, it is quite likely that there is some kind of fraudulent activity going on.

To avoid all these, Verification is a mandatory act. As and when the verification procedure stumbles upon, your claim will also cease to be approved.

However, most often you will find out that there is feedback affixed. In case the client ID is given wrong, you can easily get it checked and then go for another claim.

Also Read : PR204 Denial Code Description | Not Covered under Patient Current Benefit Plan
                 : PR 27 Denial Code - Coverage Terminated

Why Does One Need a PR Code?

We have already discussed in detail that the PR 31 Denial Code stands for all those times when your verification was not successful.

However, why does one need these codes at all? There is a high possibility that with so many clients, the instances for denial are not the same, right?

Therefore, there are a myriad of possibilities that open up. To ensure that one has the right kind of knowledge about the denial, the codes are affixed.

Honestly speaking, it is also very useful to have a PR code as it will help one to organize the instances. Most often one would notice that whenever the claim is rejected, you will receive the reason in the format of the code.

The PR Denial Code is particularly very vital for all kinds of medical billing. Hence, if you see the PR 31 Denial Code on your claim, it is best to understand that there was some kind of a discrepancy with your verification. And they failed to register you as a potent client of the service. 

How to Handle PR 31 Denial Code in Medical Billing Process

There are some steps which we have to follow to handle this denial as mention below

1– The very 1 step to check patient’s eligibility on insurance website which is denying the claim as pat can’t be identified.

2- If found patient is eligible and active on insurance then just check your software may be some typo error in patients name or policy number and all is correct and patient is active eligible.

3. If there is some discrepancy then please do corrections and submit a corrected claim. If no discrepancy found then

3- Called to insurance company and ask them for reprocess because all information is correctly updated.

Note- CO 31 or PR 31 denial is handled in same way and also same denial. Some times we found female patient name or middle or last name changed after marriage so this also a issue to get PR 31 denial code.


  • NSingh (MBA, RCM Expert)

    The author and contributor of this blog "NSingh" is working in Medical Billing and Coding since 2010. He is MBA in marketing and Having vaste experience in different scopes of Medical Billing and Coding as AR-Follow-up, Payment Posting, Charge posting, Coding, etc.

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