CARC 31: Patient cannot be identified as our insured.
Patient cannot be identified as our insured.
CARC 31 appears on the 835 ERA (Electronic Remittance Advice) that the payer returns after claim adjudication. It explains a reduction, denial, or payment adjustment to your billing team. For your practice, the question is workflow: identify the pattern, route the denial to the right resolution path (rebill, appeal, write-off), and recover what's recoverable without burning RVU time on dead-end fights.
What CARC 31 means
The official X12 description is: “Patient cannot be identified as our insured.”
In plain language: Patient cannot be identified as our insured.
Practice workflow for CARC X 31
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
CARC 31 group codes explained
On the 835 ERA, CARC 31 appears alongside a group code that signals who is financially responsible for the adjustment. CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
Frequently asked questions
What does CARC 31 mean?
Patient cannot be identified as our insured. In plain language: Patient cannot be identified as our insured.
Is CARC 31 appealable?
CARC 31 is usually not appealable on its own — it's typically a contractual, informational, or routine adjustment. Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
Which group code does CARC 31 appear under?
CARC 31 most often appears under: CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
What should I do if I see CARC 31 on the 835?
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
Related resources
Sources
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