How does Counterclaim generate an insurance appeal letter?

Counterclaim uses a 5-agent AI pipeline. The Reader extracts claim data from your document. The Researcher identifies applicable state insurance law. The Writer drafts a formal appeal letter. The Adversary identifies weaknesses. The Editor rewrites the letter to eliminate all weaknesses. The final letter is ready to print and mail in minutes.

Is Counterclaim free to use?

Yes - Counterclaim is free during the launch period. Upload your denial letter and receive a complete adversary-tested appeal letter at no cost. No account required.

What types of insurance denials can Counterclaim handle?

Counterclaim handles all major denial types: medical necessity (CO-50), prior authorization (CO-11), experimental treatment (PR-1), fee schedule (CO-45), timely filing (PR-27), not covered (CO-4), step therapy (PR-50), and missing information (CO-16).

What file formats does Counterclaim accept?

Counterclaim accepts PDF files, JPG and PNG photos, and scanned documents of your denial letter or Explanation of Benefits (EOB).

Does Counterclaim provide legal advice?

No. Counterclaim generates appeal letters based on publicly available legal and clinical information but does not constitute legal advice. For complex cases, consult a licensed healthcare attorney or certified patient advocate.

What does CO-31 mean on my Explanation of Benefits?

CO-31 means 'patient cannot be identified as our insured.' The insurer could not match the patient on the claim to an active member in its system. This is typically caused by a data error, such as a wrong member ID or a name or date-of-birth mismatch, rather than an actual lack of coverage.

Does CO-31 mean I do not have insurance?

Usually not. If you had active coverage on the date of service, CO-31 almost always reflects a clerical mismatch between the claim and the insurer's records. Verify your coverage was active that day, then focus on correcting the identifying information that prevented the claim from matching your policy.

How do I fix a CO-31 denial?

Pull out your insurance card and compare every identifying detail to what the provider submitted: member ID, your name exactly as printed on the policy, date of birth, and group number. Provide the correct details to the provider's billing office and ask for a corrected claim. If the error is in the insurer's enrollment record rather than the claim, call member services to correct your record first.

Why does my name cause a CO-31 mismatch?

Insurers match on exact identifiers, so a name that differs from the policy can cause a mismatch: a maiden versus married name, a hyphenated surname entered without the hyphen, a middle name or suffix included or omitted, or a nickname used instead of the legal name. Make sure the claim uses your name exactly as it appears on your insurance card and policy.

What if my coverage was active but the insurer still cannot find me?

If you are certain coverage was active on the date of service, the insurer's eligibility file may be out of date, for example, a recent enrollment, plan change, or employer update that did not post correctly. Contact member services to confirm and correct your enrollment record, obtain confirmation in writing if possible, and then have the provider resubmit the claim against the corrected record.

CO-31

How to Fix a CO-31 'Patient Cannot Be Identified' Denial

Claim denied with CO-31 because the patient cannot be identified as insured? This eligibility mismatch is usually a typo in the member ID or demographics. Learn how to fix it fast.

What does CO-31 mean?

A CO-31 denial means the insurer cannot identify the patient as its insured. The claim's member ID, name, date of birth, or other identifying details did not match an active record in the insurer's eligibility system. CO-31 is an eligibility and data-matching problem, it does not mean you lack coverage, it usually means a small data error prevented the claim from matching your policy.

Why insurers issue CO-31 denials

CO-31 is almost always caused by a mismatch between the information on the claim and the information in the insurer's records. Common triggers: a mistyped member ID, a name that does not match the policy (a maiden name versus married name, a hyphenation difference, or a nickname), an incorrect date of birth, a wrong group number, or a claim sent to the wrong insurer entirely. Because it is a data problem, it is usually fixed quickly once the correct identifying details are confirmed and resubmitted.

Appeal strategy

Compare the information on the claim against your current insurance card exactly. Verify the member ID, the spelling of your name as it appears on the policy, your date of birth, and the group number. Give the provider's billing office the exact details from your card and ask them to correct and resubmit the claim. If your coverage was active on the date of service but the insurer's eligibility file is wrong, contact member services to correct your enrollment record, then have the provider resubmit. Confirm you were not accidentally billed to a former insurer.

Frequently asked questions about CO-31

CO-50

Medical Necessity Denial (CO-50)

CO-11

Prior Authorization Denial (CO-11)

CO-55

Experimental Treatment Denial (CO-55)

CO-45

Exceeds Fee Schedule Denial (CO-45)