What is the denial code for patient not eligible?

It depends on why. CO-27 means coverage had ended, PR-26 that it had not started yet, PR-200 that it was lapsed on the date of service, CO-31 that the payer cannot find the member, and CO-140 that the member's name and ID do not match. Re-running eligibility for the date of service usually shows which one applies.

How do I prevent eligibility denials?

Verify eligibility electronically before every visit, not only the first, and again before billing a service delivered weeks earlier. Capture new insurance cards at each visit, and check that the name and date of birth on the claim match the payer's record exactly.

Eligibility and coverage denial codes

Eligibility denials say the payer could not attach the service to active coverage, and the code tells you why. CO-27 means coverage had ended before the date of service, PR-26 that it had not yet started, and PR-200 that it was suspended or lapsed on that date. CO-31 means the payer found no member matching the identifiers on the claim, and CO-140 that the ID resolves to a member whose name does not match. PR-33 means the subscriber's policy covers the subscriber alone, so a dependent's care is not covered under it.

Also described as: patient not eligible; coverage terminated; member not found; policy inactive; name and ID do not match; dependent not covered.

The 6 codes and what separates them

CO-27 - Expenses were incurred after coverage terminated
The patient's coverage under this plan ended before the date of service.
Who pays: Patient or new plan
PR-26 - Expenses were incurred before coverage began
The service happened before the patient's coverage under this plan took effect.
Who pays: Patient, if no other plan
PR-200 - Expenses were incurred during a lapse in coverage
Coverage was suspended or lapsed on the date of service, for example during an unpaid-premium grace period.
Who pays: Patient, unless reinstated
CO-31 - The patient cannot be identified as an insured member
No member in the payer's system matches the identifiers submitted, so the claim could not be attached to a policy.
Who pays: Provider
CO-140 - The patient's identification number and name do not match
The member ID resolves to a real member, but the name submitted does not match it.
Who pays: Provider
PR-33 - The policy has no dependent coverage
The subscriber's plan does not cover dependents, so the dependent's services are not covered under it.
Who pays: Patient, if no other plan

How to tell which one you have

CO-31 and CO-140 are data problems: compare the claim's member ID, name, and date of birth with the card and the payer's eligibility response, correct them, and resubmit. CO-27, PR-26, and PR-200 are about dates, so run a fresh eligibility check for the date of service - the patient often has other coverage that should have been billed instead. PR-33 needs the dependent's own coverage or a different subscriber's plan. Only after other coverage is ruled out does a date-based balance become the patient's.

Frequently asked questions

What is the denial code for patient not eligible?: It depends on why. CO-27 means coverage had ended, PR-26 that it had not started yet, PR-200 that it was lapsed on the date of service, CO-31 that the payer cannot find the member, and CO-140 that the member's name and ID do not match. Re-running eligibility for the date of service usually shows which one applies.
How do I prevent eligibility denials?: Verify eligibility electronically before every visit, not only the first, and again before billing a service delivered weeks earlier. Capture new insurance cards at each visit, and check that the name and date of birth on the claim match the payer's record exactly.

Other denial reasons

Out of network No prior authorization Not medically necessary Service not covered Bundled or not paid separately Coding mismatch or invalid code Another payer is responsible Missing information, duplicate, or late filing Provider not eligible or not credentialed Benefit or unit limit reached Deductible, coinsurance, or copay Paid less than billed

Every denial code in one table

Last reviewed October 3, 2026.

These are original plain-English summaries written for reference, not the official X12 code descriptions. Payer handling of any code varies by contract - always verify against the remittance advice and your payer agreement before adjusting a claim.