Introducing warnings for missing member IDs in eligibility checks

You’ll now get a clear warning in eligibility responses when a required member ID is missing.

Why some payers require member IDs

For eligibility checks, payers can only return coverage when the patient information in the check matches exactly one member in the payer system. To enforce this, many payers require that checks include the patient’s member ID.

When the member ID is required but missing, the payer returns a AAA error, such as 72 (Invalid/Missing Subscriber/Insured ID). These errors are generic and don’t specifically indicate the payer requires a member ID.

Stedi’s new missing member ID warning

Stedi’s new warning indicates the payer requires a member ID for patients in eligibility checks, based on Stedi’s curated sources.

The warning is returned in the warnings array, alongside the AAA error, for eligibility responses from the following endpoints:

• Real-Time Eligibility Check JSON

• Real-Time Eligibility Check Raw X12

• Poll Batch Eligibility Checks

For example, the following warning indicates the payer requires the patient’s member ID:

{
  "warnings": [
    {
      "code": "request::270::member_id_required",
      "description": "This payer requires the patient's member ID to be included in eligibility requests."
    }
  ],
  "errors": [
    {
      "code": "72",
      "description": "Invalid/Missing Subscriber/Insured ID",
      ...
    }
  ],
  ...
}

The warning is also shown for eligibility responses in the Stedi portal.

Eligibility check requirements vary by payer. If Stedi doesn't know if a payer requires a member ID for eligibility checks, no warning is returned.

For more tips and details, check out Stedi’s Eligibility troubleshooting docs.