Denial code 31, “Patient cannot be identified as our insured,” is a frequent issue that can disrupt a healthcare practice’s revenue cycle. This denial occurs when there’s a mismatch between the patient information provided on the claim and the insurer’s records. To avoid these costly denials, it’s essential to understand the root causes and implement strategies that minimize the risk of revenue loss.
Common Causes of Denial Code 31
There are several reasons why denial code 31 might appear:
- Incorrect patient information: Simple errors in the patient’s name, date of birth, or insurance ID number can trigger denials.
- Eligibility issues: The patient may not be eligible for coverage, or their plan may not cover specific services.
- Coordination of Benefits (COB) issues: For patients with multiple insurance plans, COB rules must be followed to prevent claims from being denied.
- System errors: Technical glitches or outdated systems may cause claim rejections even if the information is correct.
Effective Strategies to Prevent Denial Code 31
Here are proven strategies to help reduce denials and keep your revenue cycle flowing:
- Data Entry Accuracy: Ensure that all patient information, including names, dates of birth, and insurance IDs, is entered correctly. This can significantly reduce claim rejections.
- Thorough Eligibility Verification: Always verify the patient’s eligibility before providing services. Use online verification tools or contact insurers directly to ensure coverage.
- Patient Age Verification: Confirm the patient’s age to ensure that their insurance plan covers the services provided.
- Check Insurance Coverage Period: Make sure that the patient’s insurance is active during the time of service. Knowing the coverage dates can prevent issues with expired policies.
- Coordinate Benefits Properly: For patients with multiple insurance policies, ensure proper coordination between primary and secondary payers to avoid COB-related denials.
- Leverage Advanced Billing Software: Invest in advanced billing software that automates eligibility checks and flags potential issues before submitting claims.
Additional Tips:
- Train Staff on Best Practices: Ensure that your staff is trained in proper data entry and claims submission protocols to avoid simple errors that lead to denials.
- Monitor Denial Trends: Regularly review denial codes and patterns to identify areas that need improvement.
- Invest in Technology: Utilize billing software that tracks, monitors, and resolves claims more effectively.
Partner with Claims Med for Revenue Cycle Management
Tackling denial code 31 requires a strategic approach. By partnering with Claims Med, a leading provider of revenue cycle management solutions, healthcare practices can significantly reduce denials and optimize their financial health. Claims Med offers expert guidance, cutting-edge technology, and dedicated support to streamline your billing processes and boost your bottom line.
Contact Claims Med today to learn how we can help your practice overcome claim denials and achieve financial success.