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Key Takeaways
- Insurance payers send the PR 31 denial code to inform the provider that the patient is not part of their claim database.
- There is a practical way of solving this denial code, whether it is caused by incorrect patient information, outdated COB or insurance card, or wrong primary payer-recipient.
- If the issue persists, this denial can have financial implications, including revenue leakage.
- A reliable billing partner can eliminate PR 31 denial codes by providing practices with a strong insurance verification system, a data review mechanism, and a robust denial management system.
- After a few days of fixing the denial, you can seamlessly process claims and receive reimbursement.
Whenever a PR 31 denial code is transmitted in your practice, we treat it as a major billing emergency, and that is totally understandable. It could mean a complex issue in your patient’s insurance coverage, information, or payment transmission. In more ways than one, you can stop PR 31 denials from delaying your practice’s revenue.
Credex Healthcare’s PR 31 denial management identifies patient status, eligibility, and payer data issues, corrects claim errors, and manages appeals and resubmissions through its specialists. In this blog, we explain what the PR 31 code is, why it occurs, and how to handle this denial code.
What Does PR 31 Denial Code Mean?
PR 31 denial code gatekeeps verification of the patient’s insurance coverage, mainly because the system or database cannot identify the patient. This trigger is caused by information mismatches, an incorrect patient ID or policy number, or expired coverage. This can cause trouble in your practice in many ways, from administrative to financial. Patients can feel wronged when they thought they were insured, while you risk delayed payments and claim denials.
Sometimes a patient provides an outdated insurance card. Some others accidentally enter their DOB or name incorrectly on their registration forms. Minor errors, such as extra spaces, can trigger a system mismatch. If a payer identifies these errors, it returns a PR 31 denial code, and the provider must address it promptly and resubmit the claim as a refiled claim.
Common Reasons for PR 31 Denials
PR 31 denials result from entry errors related to patient information and credential entry. For example, if the patient’s declared full name doesn’t match the one in the insurance company’s database, the claim will not go through. The same goes for minor errors, such as a missing middle name or a typo. Another error is the one in the insurance ID digits. Obviously, this happens when the digits are entered incorrectly.
Another reason is outdated information. The patient may have changed employment, insurance coverage, or room plans and forgotten to inform the provider. They may also not have updated their insurance card. This can also trigger a denial code and needs to be updated. Contact our medical billing experts to prevent PR 31 denials, along with ways to accelerate reimbursements and means to protect your revenue.
How to Fix PR 31 Denials
Fortunately, receiving a PR 31 correspondence is not the end of the world for your practice. There is always a step-by-step process to address any denial reasons. First, review the denial correspondence that could give you an idea of why a specific claim is denied. Then, verify the patient’s personal information to ensure that there’s no mismatch. You can also verify the patient’s whether its coverage is active.
If there are any information mismatches, promptly inform the patient to avoid future denials. Reprocess the claim depending on the denial reason and resubmit it, subject to payer appeal monitoring.
Best Practices to Prevent PR 31 Denials
Resolving our claims head-on is one thing, but putting best practices in place to prevent future denials is another. Proactivity matters in dealing with these denials. This approach can range from training staff to spot common patient-information errors and initiate insurance verification to advising practices to use real-time eligibility workflows to check patients’ coverage status.
Another best practice is to follow a standard data entry format agreed upon by the practice and partner payers. Minor errors, such as in spacing or suffixes, can trigger a denial. Lastly, ensure your billing software sends claims to the correct clearinghouse and that the payment list is accurate.
What Happens if You Ignore PR 31 Denials?
Administrative. At the end of patient interactions, a PR 31 denial could mean the patient is at fault, especially if their information is incorrect. This situation can make them feel uncomfortable and question their trust and loyalty to the practice that handles their information.
Operational. A PR 31 denial can signal a broken billing workflow that needs to be addressed as soon as possible. This could expose inefficient data-entry protocols and a faulty insurance eligibility process that unknowingly lets claims leave the practice’s billing system unchecked.
Financial. The most direct effect of a PR 31 denial is revenue leakage, as claims with this denial code cannot be processed unless they are resubmitted. If left unaddressed, the practice’s cash flow is disrupted, and thousands of dollars in reimbursement will never be paid.
How Long Does It Take to Fix PR 31 Denials?
PR 31 denials can be resolved within a few days if caught early. However, the timeline depends on how quickly you resolve it and whether you are updating patient information or coordinating with the insurance payer. Once you correct the identified errors and submit the claim promptly, you can receive reimbursement quickly.
At Credex Healthcare, we have an established workflow, from insurance eligibility systems to proactive denial management, to resolve PR 31 denials with a guaranteed 72-hour refiling. Providers don’t have to wait weeks for issues to be resolved.
Why Choose Credex Healthcare for Denial Management
Resolving PR 31 denials, when done right, can free your administrative, operational, and financial burdens all at once. All you need to do is partner with a company that knows how to target these dimensions. Credex Healthcare’s billing specialists are trained in eligibility review, payer regulations, claim monitoring, and appeals systems. We apply a proactive, prompt approach to preventing PR 31 denials, whether they have already occurred or will in the future.
Our medical billing and medical credentialing services make your practice organized, compliant, and financially sound through our proactive insurance eligibility systems and AI-powered data scrubbing and claims management, perfect for all practice sizes, provider rosters, and medical group arrangements.
Partner with Credex Healthcare for real-time eligibility reviews, payer-responsive claim monitoring, and strategic claims monitoring to simplify how you manage denials.
Conclusion
The PR 31 denial code occurs frequently and can have several causes. To proactively review vulnerable claims, ensure your patient information is accurate and matches the insurance payer records. With robust claims management and billing support from a premier company like Credex Healthcare, PR 31 denials can no longer disrupt your revenue cycle.
FAQs
What does the PR 31 denial code mean?
A typical prompt that provides context for this denial code is “the patient cannot be identified as our insured.” This denial code prevents the claim from being processed and is primarily triggered by an information error or mismatch.
Why did a practice get the PR 31 denial?
Practices can receive a PR 31 denial for various reasons. It could be due to outdated or expired insurance coverage, incorrect or mismatched patient information, or the wrong payer-recipient or clearinghouse.
What can I do to fix the PR 31 denial code?
To resolve this denial, you need to know the exact reason for the denial, verify insurance coverage and patient information, and inform the patient about the denial and the practice’s action plan.
Are PR 31 denials avoidable?
Yes. You can avoid such denial correspondence by proactively subjecting patients’ insurance coverage to eligibility review, scrubbing patients’ information to automatically detect any discrepancies, and actively monitoring appeals, which are flagship services of reliable billing companies.
What happens when a patient doesn’t know their primary payer?
Billing companies, like Credex Healthcare, coordinate directly with insurers to verify the patient’s COB status and affiliations. Our billing specialists gather critical patient information to resolve coverage issues and discrepancies.
