PR-31 Claim Adjustment Code.

by KARTHIKEYAN K
(CHENNAI)

We are received denial reason PR-31 for the claim, What action we will take for the particular CPT.


Response:

I'm assuming your insurance payer is using the standard ANSI X12 Claim Adjustment Reason Codes.

The first two letters, "PR" stand for Patient Responsibility. The "31" numeric code means "Patient cannot be identified as our insured."

This means the insurer can't find the patient in their system. This can be caused by something a simple as a typo in the insurance ID, date of birth, or name. It can also mean that the insured insurance is no longer valid in which case the patient would be responsible for the charges. I don't know that the code is associated with specific treatment codes, but with the insurance coverage for the whole claim.

Hope this helps. If any other visitors have experience with the PR-31 claim code, please click on the link to share your comments below.

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