Insurance denied as - Unable to identify patient

Unable to identify patient 

Denial Code : CO 31 Claim denied as patient cannot be identified as our insured 


This may be due to two things:
(a) the coverage details given in source document may be incorrect and
(b) data entry error.

If this is due to the latter, it may be due to the fact that the operator has entered the patient name or the id # or the insurance company number incorrectly. This is a serious error and we need to find out why the system had failed to track this. We should correct this and resubmit the claim immediately.

If we have entered all the information correctly even though the claim was denied the same then, We need to send the claim along with the card copy and also we need to check the claim submission address which was printed in the back side of the card copy.

However follow up needs to be done to correct the claim and resubmit.

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insurance denial - Patient/insured health identification number and name do not match

Denial Messages:

CO 140: Patient/insured health identification number and name do not match.

CO 13: The date of death precedes the date of service.

Services were denied for one or more of the following reasons:

• Patient cannot be identified as our insured. The name or Medicare number was incorrect or missing. Please check the patient’s Medicare card.

• The date of death precedes the date of service.

• Expenses were incurred prior to coverage.

• Expenses were incurred after coverage terminated.

• Expenses were incurred prior to coverage. The service was not covered by Medicare at the time the patient received it.

Suggestions to reduce or eliminate these kinds of claim denials:

• Patient screening is vital to an office’s success in capturing the necessary information for correct claim submission.

• Office staff should obtain additional patient information when registering patients. Usually this is accomplished by the patient completing a medical information/history and insurance information form.

Pay close attention to:

o Obtaining the patient’s full name directly from the card.

o Patient address and phone number.

o Obtaining the name and identification number of other insurance (Medicare or other type of insurance plan involved).

o Date of birth.

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