Denial code PR-31

What does Denial code PR-31 mean on a medical bill?

PR-31 means the plan could not match the person on the claim to anybody it covers. Most of the time this is a typing problem: a member number off by a digit, a former last name, a date of birth entered wrong, or a child filed under their own name instead of the subscriber's. The PR letters push the amount to you, but the claim never got as far as a coverage decision, so nothing about your care was reviewed. That is why paying a PR-31 balance before it is fixed usually means paying for care the plan would have covered.

What should I watch out for with Denial code PR-31?

• Read your member number and date of birth back to the billing office, digit by digit
• Ask the billing office to refile under the subscriber's information when the patient is a dependent
• Ask your plan to confirm you were covered on that date before you treat the balance as yours