Using Stedi insurance discovery for revenue recovery

To submit a claim, the provider needs the patient's payer and member ID.

Both are on the patient's insurance card, but the card often isn't enough. The patient forgets it, brings a card from an old plan, or mistypes the details on an intake form. In emergencies, the provider may not be able to collect the information at all.

When a patient's insurance information is missing or wrong, the provider's only option is to try to contact the patient. That doesn't always work.

Eventually, the provider writes off the claim. The claim’s revenue is lost.

Stedi insurance discovery checks can help providers recover that lost revenue. This guide explains how they work, when to use them, and how they fit alongside the checks providers already run.

What is insurance discovery?

Insurance discovery finds a patient's active coverage using only their demographic information, like name, date of birth, and address. Patients are likely to know these details, and those details tend to stay consistent across payers.

If the check returns active coverage, the response contains the same data as an eligibility check. You'll get the patient's payer ID and member ID, which can be used to submit the claim.

How insurance discovery helps recover lost revenue

A common reason for unpaid care is missed coverage. For example, the patient may have been insured at the time of service, but the provider didn't capture the right payer or member ID.

Insurance discovery can find active insurance coverage for a past service date. When it does, you get the payer ID and member ID needed to bill the payer. That turns an unbillable claim into one you can submit and collect on.

Can providers use the Stedi portal to run insurance discovery checks?

Yes. Providers can submit discovery checks using the Create insurance discovery check form in the Stedi portal.

Do providers still need to run eligibility checks at patient intake?

Yes. Insurance discovery is a fallback, not a replacement, for eligibility checks. Only use discovery checks when an eligibility check isn't possible or returns no active coverage.

Running eligibility checks at patient intake – on the service date – helps avoid the need for revenue recovery in the first place.

For patients who are likely covered by Medicare, such as those 65 or older, an MBI lookup is a targeted alternative to an insurance discovery check.

An MBI lookup returns the patient's Medicare Beneficiary Identifier (MBI) and, if found, the patient's complete eligibility response from Medicare. You can run MBI lookups using only the patient’s demographic information and (optionally) Social Security Number (SSN).

Does insurance discovery affect timely filing limits?

No. Insurance discovery can find patient coverage for a past service date, but the payer’s timely filing limits still apply.

A timely filing limit is the payer’s deadline for submitting a claim. Filing windows vary by payer. Some commercial payers require claim submission within 60-90 days of the service date. The payer may automatically reject or deny claims submitted outside this window, meaning the payer won’t pay.

Tip: Because of timely filing windows, a claim is less likely to be recoverable – and so less valuable – the longer it sits unsubmitted. We recommend providers run insurance discovery checks as soon as a claim stalls due to missing payer information.

Do providers have to switch clearinghouses to use Stedi’s insurance discovery checks?

No. Providers don’t have to use Stedi for claim submission, ERAs, or eligibility checks to run insurance discovery checks. Providers can run insurance discovery checks through multiple clearinghouses, including Stedi, at the same time. We encourage providers to compare Stedi against their current clearinghouse in production to evaluate performance, reliability, and support.

What are the limitations of insurance discovery checks?

Insurance discovery is useful as a fallback, but it has limits:

• Slower than eligibility checks – up to 120 seconds. Most eligibility checks return results in 1-3 seconds.

• Not guaranteed to return results, even with strong demographic input.

• Not for dental or vision use cases. Insurance discovery primarily checks medical coverage. Some payers may return dental or vision coverage, but discovery checks won't return results for dental-only or vision-only payers.

• No payer primacy. If discovery returns multiple coverages, follow up with a Coordination of Benefits (COB) check to determine which payer is primary.

Get started with Stedi insurance discovery

Insurance discovery is available on all Stedi production accounts.

To get started, sign up for a free sandbox account. It takes less than two minutes. No credit card is required. Then upgrade to production whenever you're ready. There are no monthly minimums or setup fees. You only pay for the transactions you use.