CO 31 Denial Code- Patient cannot be identified as our insured

CO 31 Denial Code- Patient cannot be identified as our insured:

Insurance will deny the claim with CO 31 Denial Code – Patient cannot be identified as our insured, when the claim submitted with incorrect Name/Date of Birth/Gender/Insurance ID or it may be denied when the claim submitted to an incorrect insurance or submitted to wrong insurance.

For examples:

1. Assume XYZ billing submitting the claim for patient name John by keying incorrect Insurance ID and billed the claim.

When insurance company receives the claim, they will be unable to find the patient through the given insurance ID and may deny the claim as CO 31 as Patient cannot be identified as our insured. So in this case we need to find out why they cannot find the patient by calling or by checking patient eligibility through website.

2. Similarly, assume ABC Billing submitted the claim for patient name Chris to a wrong insurance.

When the claim received by a wrong insurance, they will be unable to find the patient as they won’t be having any data of this patient to identify. Hence they deny the claim with CO 31 Denial Code – Patient Cannot be identified as our insured.

This type of scenarios we come across mostly while submitting the claims through paper submission. Because they do paper submission manually and in bulk, so while submitting to the insurance they may enter incorrect insurance and submit the claim to the wrong insurance (Which ends up with the denial).

What action needs to be taken in order to resolve the CO 31 Denial Code- Patient cannot be identified as our insured:

When you get this type of denials or rejections, first need to check the following information in the application (Billing software) in order to resolve the issue:

• Check the previous date of service notes to find, if they have got any denial/rejection before and whether it’s already been corrected with correct patient Name/Date of Birth /Gender/Insurance ID.
• Review patient chart to get the correct Name/Date of Birth /Gender/Insurance ID of the patient.
• Check for the Patient insurance card copy.

If the information not available in any of the above steps, then try to find out the eligibility of patient through website. If the infotrmation found, then update the correct information in the claim and mark as “Corrected Claim” in block # 19 and resubmit the claim. (Important Note: After correction resubmit all open claims of this patient).

If there is no information found, then patient needs to be contacted for correct insurance information.

Call the insurance claims department and ask the following question and try to find out correct details of patient or insurance details, if you get CO 31 Denial Code- Patient cannot be identified as our insured:

• Check with rep, can they find the patient through policy number or patient subscriber info (If patient not self)?
• If rep not able to find, then try to find the patient through Patient first Name, Last name and date of birth. (If patient found, then get the correct details of the insurance, update and resubmit the claim).
• If not, check with patient social security number, telephone number and address?
• Get the claim number and Cal reference number? (Note: Patient needs to be contacted if unable to find the correct insurance details in application or with representative).