CARC31ReferenceCurrentVerified Aug 15, 2026CARC 31
AR Guide Workflow
Eligibility & Coverage
Coverage could not be verified or was not active for the date of service — member not found, coverage lapsed, or eligibility requirements not met.
AR Guide explanation
What it means
The payer cannot identify the patient as their insured.
AR Guide knowledge
Common denial category
Eligibility & Coverage — Coverage could not be verified or was not active for the date of service — member not found, coverage lapsed, or eligibility requirements not met.
AR Guide knowledge
Common causes
- Wrong member ID on the claim
- Patient's name/DOB mismatch
- Coverage not found under the ID submitted
AR Guide knowledge
What AR should verify
- Verify the member ID, name and date of birth against the member card
- Run eligibility verification with the corrected information
AR Guide knowledge
Recommended action
- Correct the subscriber information and resubmit
- If the patient is not covered, verify with the correct plan before billing
AR Guide knowledge
QA checkpoint
- Verify eligibility before rendering service
- Keep a copy of the member ID card in the patient record
About this guidance: Note
AR Guide knowledge is general reference content written by our team — it is not payer-specific policy and never replaces the payer’s documentation or your contract. Always confirm specifics with the payer.