PR-31 — Patient cannot be identified as insured
Claim-adjustment reason code 31 · typically reported as PR-31 or CO-31
What it means
The payer can’t match the patient to a member record — name, ID, or DOB doesn’t line up.
Why DME claims hit it
- Transposed member ID at intake
- Patient gave an old card (esp. MBI vs. legacy IDs, or MA plan changes)
How to fix it
- Re-photograph/re-key the current card; run a fresh eligibility check; resubmit with corrected identifiers
Appeal posture
No — correct the identifiers and resubmit.
Related denial codes
CO-140 — Patient ID and name don’t matchCO-26 — Expenses incurred before coverage beganCO-27 — Expenses incurred after coverage ended
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