PR 31 Denial Code: Description, Reasons & Resolution Guide 

At Credex Healthcare, we know how frustrating it is when claims are denied. That is why providers nationwide trust us as their top billing partner. Credex Healthcare is the finest medical billing company, and we take pride in claiming that we solve the problem of denials by resolving them in a short period, making clean claims, and ensuring practices receive payment on time.  

PR 31 Denial Code is a common issue in billing. When your practice encounters this denial, there’s no need to panic. We will help you understand it, fix it, and prevent it from happening again. 

What Does PR 31 Denial Code Mean? 

The denial code PR 31 implies that the insurance company is not able to recognize the patient. The payer will say, in effect, that they do not detect the individual as covered in their system. That can be confusing, particularly when the patient presents you with a working insurance card. However, mistakes in data are frequently the cause of this denial.  

One of the items that the insurance organization matches specifically is the name of the patient, the date of birth, gender, and policy ID. The same can happen to the claim when any single detail is incorrect; the payer will reject the claim. 

Sometimes, the patient provides an old or outdated insurance card. In other cases, there might be a wrongly entered birth date or a misspelled name at the front desk. Even extra spaces or errors in the plan type can cause a mismatch in the system. Upon occurrence, the payer then returns a PR 31 code rather than payment. It implies that the provider must do this quickly, so that the problem is rectified and the claim re-filed. 

Common Reasons for PR 31 Denials 

PR 31 denials occur due to many reasons. Incorrect patient demographics is one of the most common reasons. Whenever there is a mismatch between the patient’s name on the claim and the one held by the insurance company, the claim will be declined. It can create issues even when it is as simple as an overlooked middle initial or a typo. The other cause is when there is an incorrect insurance ID number. The possibility of error exists that a number may have been entered wrong or inverted. 

The other primary reason is old information about insurance. A patient can have changed job, or room plans and forgotten to communicate with the provider. Or they may present an insurance card that expired some time back and was forgotten. When that happens, the insurance company does not take them since they have moved out of the cover.  

Others may involve incorrectly selecting the payer ID in the billing program, entering bills in the wrong clearinghouse, or submitting claims to the wrong clearinghouse, all automatically. 

How to Fix PR 31 Denials 

It is not difficult to reverse a PR 31 denial when you know the right things to look out for. As the initial step, it is recommended to check all details of the patients. Verify the patient’s name, date of birth, and insurance ID once again. Cross-check between what is written on the claim and what is on the insurance card. See that all the details match. In case of something inappropriate, fix it and resubmit the claim. 

In case you do not locate the problem, the insurance company should be called next. Ask them whether the patient is active on the date of service. Inquire about the information that they hold in their system. They can give you an excuse that the patient has changed plans or that the insurance has run out. It will assist you in evaluating whether the patient used the wrong card or switched their plans unannounced. 

Best Practices to Prevent PR 31 Denials 

The most effective procedure to prevent PR 31 is to prevent it before it occurs. That begins with great training at the front desk. Insurance verification must never be missed, even in repeat patients. They must enquire whether the coverage of the patient is the same, and they must thoroughly look at the insurance card. It is also wise to use real-time eligibility tools that show whether a patient is active with that plan on the day of service. 

Another good habit is verifying that names, dates of birth, and IDs match what the insurance company has on record. Even small errors, like entering “John Smith Jr.” instead of “John Smith,” can lead to claim denials. Also, ensure your billing software is updated and that the payment list is correct. This helps ensure claims always reach the right place. 

All these steps are crucial at Credex Healthcare. We use clean claim technology, real-time eligibility checks, and audit-level reviews to identify issues before submitting claims. This is one of the reasons why we are considered the best billing company for healthcare providers in the U.S. 

What Happens If You Ignore PR 31 Denials? 

Failure to address a PR 31 denial may prove to be expensive. In case the claim fails to be re-filed within the stipulated time, it could exceed the time limit for filing requirements. This implies that the insurance agency will not pay the claim, not even in case you correct your mistake subsequently.  

Those are dollars lost forever to your practice once they are gone. And, if many denials of PR 31 accumulate, your accounts receivable will increase, cash flow will decline, and your office will feel overwhelmed. 

How Long Does It Take to Fix PR 31 Denials? 

PR 31 denials can also be resolved within a few days if caught early. The timeline, however, depends on how quickly the error is identified, how fast the patient information can be updated, and how quickly responses are received from the insurance company. Some payers reply immediately, while others may take a few days. If all mistakes are corrected and the claim is submitted promptly, it is possible to receive payment without significant delays. 

At Credex Healthcare, our means of correction and resubmission of PR31 denials stand at less than 72 hours. That implies that providers do not have to wait weeks to have issues resolved. We monitor every movement, contact the payers, and update them on the progress. 

Why Choose Credex Healthcare for Denial Management 

It involves denials that require time, skill, and effective systems. This may not be well handled by just any billing company. At Credex Healthcare, we specialize in resolving denials, especially the more challenging ones like PR 31. Our staff is also trained in payer regulations, eligibility investigations, plans, updates, and appeals. We prevent denials from happening in the first place, and when a denial does occur, we resolve it very quickly. 

We will also provide billing and credentialing services and ensure your practice is in order, compliant, and profitable. We include all of the big commercial payers, Medicare/ Medicaid, and managed care plans. Whether you’re a solo practice or a multi-specialty group, we customize our services to meet your needs. 

As long as you have Credex Healthcare on your team, you don’t need to worry about lost claims or coding errors. We make billing simpler and less messy. That’s why healthcare providers all across the United States trust us. 

Conclusion 

The refusal code PR 31 happens quite often, but it does not always cause issues. You can monitor your claims and protect your revenue by understanding what it means and how to fix it. Make sure patient data is accurate, insurance details are current, and claims are clean. With a strong front desk process and a skilled billing team like Credex Healthcare, PR 31 denials can be resolved quickly and prevented in the future. 

Frequently Asked Questions (FAQs) 

1. What is the meaning of the PR 31 denial code? 

According to PR 31 denial code, a patient is on another primary insurance, which should be billed in advance of the current claim. It implies that the claim was first presented to the incorrect payer, or a coordination of benefits (COB) was not updated. 

2. Why get the PR 31 denial? 

Billing the incorrect insurance as the primary payer, outdated insurance data, and the lack of a coordination of benefits on record with the payer commonly lead to this denial. 

3. What can I do to fix the PR 31 denial code? 

The only way to resolve a PR 31 denial is to process a correct insurance order for the patient, update the COB with the payer, and submit the claim to the correct primary insurance responsibly. It might also be necessary to fill out a corrected claim if the insurance order is changed. 

4. Will PR 31 denials be avoidable? 

Indeed, verifying insurance on each visit, checking COB status, and using electronic eligibility tools can greatly reduce the likelihood of a PR 31 denial. 

5. What happens when the patient is unaware of what plan is a primary? 

Call both insurance companies to verify the COB information. Other payers can follow the birthday rule or base it on their employment or court ownership.