CARC 31OA · Other Adjustment
The payer's records don't show this patient as a covered member under the policy information submitted.
- Common causes
- Incorrect member ID, a name misspelling, wrong date of birth, or the patient is enrolled under a different subscriber or policy than what was billed.
- Suggested fix
- Verify the patient's insurance card details and resubmit with corrected identifying information.
Related Other Adjustment codes
109This payer isn't responsible for this claim; it needs to be sent to a different payer or contractor.136The claim wasn't processed correctly because it didn't follow the rules or requirements set by a prior (primary) payer.140The member ID number submitted doesn't match the patient or subscriber name on file with the payer.18This claim or service line is an exact duplicate of one already submitted and processed.19The payer has determined this claim relates to a work injury or illness, making workers' compensation the responsible party instead.215Payment was adjusted based on a third-party settlement where the payer has subrogation rights to recover costs.22The payer believes another insurance plan should be billed first or is otherwise responsible under coordination-of-benefits rules.23This adjustment reflects how a prior payer already processed the claim, reducing what this payer pays as a result.
Frequently asked questions
What does CARC 31 mean?
The payer's records don't show this patient as a covered member under the policy information submitted.
How do I resolve CARC 31?
Verify the patient's insurance card details and resubmit with corrected identifying information.
Why does CARC 31 happen?
Incorrect member ID, a name misspelling, wrong date of birth, or the patient is enrolled under a different subscriber or policy than what was billed.
CARC codes maintained by X12 (x12.org). Descriptions on this site are original reference interpretations. Always verify codes with authoritative sources before making billing decisions.