CO31 denial code description and corrective action

Patient cannot be identified as our insured.

This denial occurs mostly when we billed claim with incorrect patient name, gender or DOB.

The most important step is to determine whether the claim denial is valid or if the insurance has denied the claim by mistake.
Call the insurance company and ask the representative to search for the patient using their name, date of birth (DOB), or Social Security Number (SSN).
If the patient is found, confirm the correct member ID associated with the patient and also verify the effective coverage period.
If the claim is found under this ID, then proceed according to the claim status. Never forget to get correct claim number.
If the claim is not found, then after verifying the timely filing limit and confirming that the insurance was active on the DOS, rebill the claim using the correct member ID.
If the member is found but coverage is shown as inactive on the DOS, try to obtain the active policy from available resources such as member history, documents, or by contacting the member. If an active policy is found, then after verifying eligibility and the timely filing limit, bill the claim to the new insurance.
If no active policy is found, then release the claim to the member.
Sometimes an incorrect name, DOB, or gender is used. After verifying the correct information with the insurance representative or portal, rebill the claim with the updated details.
Always use the most updated format of the member ID provided by the insurance, and never forget to include any required prefix in the ID, such as with BCBS.