PR-31Patient ResponsibilityEligibility
PR-31 Denial Code: Patient cannot be identified as insured
The patient cannot be identified as our insured — the payer has no matching member record.
Why PR-31 happens
- ●Member ID, name, or DOB typo on the claim
- ●Patient gave an outdated card
- ●Newborn or dependent not yet added to the policy
How to fix a PR-31 denial
- 1
Re-verify demographics and member ID against the card and eligibility response
- 2
Correct and resubmit the claim
- 3
Contact the patient for updated insurance if no match exists
How to prevent it
Scan cards, use eligibility responses to auto-correct demographics before claims go out.
Drowning in PR-31 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.