What does PR31 mean?


Editorial team Published on

In medical billing and insurance claims, PR 31 is a Claim Adjustment Reason Code (CARC) meaning "Patient cannot be identified as our insured."

Breakdown of the Code

  • PR: Stands for Patient Responsibility, which indicates that the financial liability or requirement to correct the record falls to the patient level.
  • 31: The specific numeric code meaning the insurance payer cannot match or find the patient's information in their active database.

Common Causes

  • Typographical errors: Mistakes or typos in the patient's first or last name, date of birth, gender, or social security number.
  • Incorrect policy ID: An erroneous subscriber or member ID number submitted on the claim form.
  • Wrong payer: The claim was accidentally sent to the wrong insurance company or secondary payer instead of the primary.
  • Inactive coverage: The patient's insurance policy has expired, terminated, or hasn't been updated (such as a new last name after marriage).

How to Resolve It

  1. Check demographics: Review patient registration forms and software records for spelling errors, incorrect birth dates, or wrong member numbers.
  2. Verify eligibility: Use real-time eligibility tools or the Payer Portal to confirm active coverage and correct policy details.
  3. Correct and resubmit: Fix any identified clerical errors or update the coordination of benefits (COB), then refile the claim with the correct information.