Claim denials are the worst nightmare for every healthcare practice. You must be thinking why. The answer to this is that claim rejections have a significant impact on your practice’s operations. It interferes with everyday work, diverts medical professionals from patient care, and affects the financial flow of your practice.
The first step towards dealing with these denials effectively is to identify the exact reason for the denial. And then, explore ways to deal with it.
So in this blog, we will discuss one of the reasons that insurance payers give for the denial via alphanumeric values – Denial code 31. Continue reading this blog to learn further what this code means and how to address this denial code effectively.
PR 31 Denial Code – Description
Before we go further to understand the description of denial code 31, there are a few questions that should be addressed. For instance, did your team member file a claim without checking the patient’s insurance coverage, or does your claim represent incorrect patient information? If the answer is yes, then here is your reason for the PR 31 denial code.
The official description of Denial code 31 is: “Patient cannot be identified as our insured.” This means that the insurance payer will deny a claim if it fails to identify the patient as its beneficiary.
This code is represented by the “Patient Responsibility (PR) – Patient Unidentified” denial category. This may happen if the patient’s information is not in the insurance payer’s database. Or you can say that this may be a human error. Human errors usually occur when a physician or biller files claims manually.
Common Causes of Denial Code 31
Denial code 31 is not limited to refusals caused by misinformation. Other reasons can contribute to the payer triggering a denial 31. Let’s discuss some of the other reasons that may lead to PR 31:
Incomplete or Inaccurate Patient Data
Starting with the first and most evident reason! Incorrect patient information. It is one of the primary reasons for denial code 31. Understandably, payers easily get confused if the physician mentions the wrong name, incorrect spelling, or other inaccurate patient details, such as date of birth or social security number, while filing a claim.
Due to these small mistakes, insurance payers usually do not identify the patient as their beneficiary and deny your claim with the PR 31 denial.
Incorrect Insurance Details
Another reason for the PR 31 denial code is if you have entered incorrect insurance information. If you enter the incorrect policy number or payer details, the claim may be sent to the wrong payer, where the insurance payer will struggle to identify the beneficiary. This also leads to delays and denials.
Termination of the Coverage
Insurance companies may also struggle to identify your patient as their beneficiary if they had terminated their coverage before the services were provided. These companies often terminate coverage of patients if they fail to pay on time, engage in any fraudulent activity, or if the company changes its policies. So, you may receive a denial code 31 if you file a claim for a patient whose coverage has been canceled or expired.
Coordination of Benefits (COB)
Sometimes, patients have multiple insurance plans, which can lead to coordination of benefits confusion. This may create complexity for billers to distinguish between primary and secondary payers. So, they may submit a claim to the wrong payer, which may also result in the payer rejecting your claim with a denial code 31.
Denial Code 31- Prevention Techniques
We understand that healthcare providers want to avoid denials. But how? The following are some preventive measures that you can take to control the occurrence of denial code 31.
Verify Patient’s Information
If you really want to avoid denial code 31, the ideal way to is to cross-check all the patient information before submitting the claim. You must recheck and confirm the correct policy number, insurance coverage, and any other relevant details to avoid minor mistakes.
Verify Insurance Coverage
Another way to avoid denial code 31 is to verify insurance coverage by communicating with patients and reviewing their plans. This verification will help you identify the correct payer and its information and coverage limitations.
Train Your Team
You can also reduce the likelihood of errors and denials by educating your staff. Your administrative staff should know how to handle large amounts of data effectively. You can conduct various training sessions and seminars for their education.
Frequently Audit Your Claims
Regular billing audits can help you recognize mistakes and inconsistencies in the patient’s data. Set up a system in your practice that double-checks the information and ensures the accuracy of the data. This approach, before submitting claims, can help you avoid the PR 31 denial code.
Denial Code 31 – Resolution Steps
How would you resolve the PR 31 denial code? Can you correct or resubmit such claims? Yes! Since denial code 31 is a soft denial, you can resubmit your claim with the correction. However, how are you going to determine which mistake led to the denial? The following are some things to think about when resubmitting claims.
- You must first confirm the cause of the denial. After receiving the PR 31 denial code, review the denied claim to identify the problem.
- Verify every piece of information included in the claim, especially the patient’s insurance number and personal information.
- Ensure the payer is correct. For instance, if your patient has both secondary and primary payers, technically, you must submit the claim to the primary payer. However, if you mistakenly filed a claim to the secondary payer, the insurance company will deny the claim.
- Verify with the patient whether their insurance has been canceled or if they are still covered. Then, take appropriate measures, such as submitting the claim to the right insurance payer.
- Lastly, if everything was correct and the payer mistakenly denied your claim, file an appeal.
How MediBillMD Can Help Resolve Denial Code 31?
The above-mentioned approach and strategies can help you manage the PR 31 denial code. Furthermore, we tried to explain the measures you can take to avoid these denials in the future. Having said that, we understand that it takes a lot of time for your billing team to rework and reverse denials. So, we suggest you hire professional denial management services from a medical billing firm.
MediBillMD can help you deal with all the billing issues, from filing error-free claims to dealing with denials, regardless of healthcare specialty. With a 98% clean claim rate, the firm can assist your medical practice in boosting its income.
