Official CARC description: “Patient cannot be identified as our insured.” Here’s what it actually means, why it fires, and how to get the claim paid.
PR-grouped twin of CO 31 — the payer additionally implies the patient can be billed. Don't statement anyone until identity work is done; it's nearly always fixable data.
Liability group: PR = Patient Responsibility — the amount can be billed to the patient (deductible, coinsurance, non-covered care) — but only after you verify the denial is correct. Mis-grouped PR denials are a common appeal win.
Also written: PR-31, PR31, “denial code 31”, “31 denial code” or “reason code 31” — same CARC, different ERA formatting.
Reason code 31 also appears under another group on the ERA. The number is the reason; the prefix decides who absorbs the money. This page covers PR 31 (Patient Responsibility). If your ERA shows a different prefix, use the matching page:
Verify against the physical card and a fresh 271
Newborns: most plans allow 30-day retro-enrollment — resubmit after
Coverage discovery tools before writing off or statementing
Correct and resubmit; keep original submission proof
No merits appeal — identity correction plus resubmission. Newborn retro-enrollment claims deserve a reprocessing request with the enrollment confirmation.
Fill in the denial facts — use placeholders, never real patient data (the letter keeps [PATIENT NAME]-style fields so you can merge real details privately). A payer-ready draft with an enclosure checklist comes back in ~20 seconds.
Your appeal letter draft will appear here.
The official CARC description for PR 31 is: “Patient cannot be identified as our insured.” In practice: PR-grouped twin of CO 31 — the payer additionally implies the patient can be billed. Don't statement anyone until identity work is done; it's nearly always fixable data.
Denial code 31 under the PR group (Patient Responsibility) means: Patient cannot be identified as our insured. The number is the reason; the PR prefix decides who is liable — the amount can be billed to the patient (deductible, coinsurance, non-covered care) — but only after you verify the denial is correct. Mis-grouped PR denials are a common appeal win.
Yes. PR 31, PR-31, PR31 and “denial code 31” are the same CARC — clearinghouses, payer portals and PM systems just print it differently. Only the group prefix (CO, PR, OA or PI) changes the meaning, because it changes who has to absorb the amount.
PR stands for Patient Responsibility — the amount can be billed to the patient (deductible, coinsurance, non-covered care) — but only after you verify the denial is correct. Mis-grouped PR denials are a common appeal win.
No merits appeal — identity correction plus resubmission. Newborn retro-enrollment claims deserve a reprocessing request with the enrollment confirmation.
The number 31 is the same reason code in both — what changes is the liability group. CO 31 is Contractual Obligation. PR 31 is Patient Responsibility, so the amount can be billed to the patient (deductible, coinsurance, non-covered care). Check the prefix on the ERA before you write anything off or bill the patient — a mis-grouped 31 is one of the more winnable appeals.