Reason Code: PR-31

Error Description:

Patient cannot be identified as our insured.

Avoiding/Correcting This Error

Services were denied for one or more of the following reasons:

• The name or Medicare number was incorrect or missing.
• The date of death precedes the date of service.
• Expenses were incurred prior to coverage.
• Expenses were incurred after coverage terminated.

To reduce or eliminate these types of claim denials, patient screening is vital to an office’s success in obtaining the essential information needed for correct claim submission.

Office personnel should obtain additional patient information when registering patients.

Usually this is accomplished by the patient completing a medical information/history and insurance information form. Pay close attention to:

• Patient’s full name directly from the Medicare ID card.
• Patient address and phone number.
• Name and identification numbers of other insurance (Medicare or other type of insurance plan involved).
  • Photocopying of all health insurance cards is recommended.
• Patient’s date of birth.

Note: Utilize NGSConnex to obtain patient eligibility and benefit information.