A list of potential errors and possible resolutions when submitting 270 eligibility checks.

Stedi payer errors

Error messagePossible causes and resolutions
Payer is not configured for {transaction type}. Please contact Stedi support to resolve.Stedi does not yet support this transaction type for this payer, or there is a mis-mapping of payer IDs. Contact us with the name of the payer, and we’ll investigate the issue.
Payer connection does not support {transaction type}. Please contact Stedi support to discuss connectivity options.Stedi has a connection to this payer, but it doesn’t currently support this functionality (real-time eligibility or claim submission). Contact us for a timeline on enabling it.
Payer is not configured. Please check our published payer list or contact Stedi support to resolve.Stedi doesn’t recognize the payer ID you provided. Double-check the Payer ID in the Stedi Payer Network, or contact us with the name of the payer, and we will help you determine the correct payer ID.
Payer is not supported. Please contact Stedi support to discuss connectivity options.Stedi doesn’t yet have connectivity to this payer. We’re likely already working on it - contact us for details about the connectivity timeline.

The following Stedi payer error resulted from an unrecognized payer ID:

{
    "controlNumber": "123456789",
    "tradingPartnerServiceId": "FOO",
    "errors": [
        {
            "code": "33",
            "description": "Payer FOO is not configured. Please check our published payer list or contact Stedi support to resolve.",
            "followupAction": "C"
        }
    ],
    "status": "ERROR"
}

Validation errors

Stedi validates the structure of your eligibility request and will not submit your request to the payer if it is missing required fields or if the data is not formatted correctly. The following Stedi validation error resulted from a missing provider object:

{
  "controlNumber": "123456789",
  "tradingPartnerServiceId": "CIGNA",
  "errors": [
    {
      "code": "33",
      "description": "Missing required field: provider",
      "followupAction": "C"
    }
  ],
  "status": "ERROR"
}

Payer AAA errors

When a payer rejects your eligibility check, the 271 response contains one or more AAA Request Validation segments that specify the reasons for the rejection and any recommended follow-up actions. Stedi includes this information in the aaaErrors object in the response JSON.

Common causes for AAA errors include:

  • Missing or incorrect information for the subscriber, dependent, provider, or payer. In this case, you should correct any errors before resubmitting.
  • Issues with payer enrollment. Many of these issues require that the provider contact the payer directly to resolve, due to PHI/HIPAA guidelines.
  • The payer’s system is down or experiencing issues. In this case, the payer may not have actually validated the data in your request. If you receive these types of errors, you should wait a few minutes and resend the request again.

Each error contains a code field that corresponds to a followupAction:

  • C - Please correct and resubmit
  • N - Resubmission not allowed
  • P - Please resubmit original transaction
  • R - Resubmission allowed
  • S - Do not resubmit; Inquire initiated to a third party
  • Y - Do not resubmit; We will hold your request and respond again shortly

AAA errors can be present at multiple different levels in the response, depending on the type. The following example shows an error at the subscriber level (subscriber.aaaErrors):

    "subscriber": {
        "memberId": "123456789",
        "firstName": "JANE",
        "lastName": "DOE",
        "entityIdentifier": "Insured or Subscriber",
        "entityType": "Person",
        "dateOfBirth": "190001103",
        "aaaErrors": [
            {
                "field": "AAA",
                "code": "75",
                "description": "Subscriber/Insured Not Found",
                "followupAction": "Please Correct and Resubmit",
                "location": "Loop 2100C",
                "possibleResolutions": "- Subscriber was not found."
            }
        ]
    }
CodeDescriptionLocationPossible causes and resolutions
41
Authorization/Access RestrictionspayerIf this error appears before the 2000A loop, it’s most likely an enrollment issue with the vendor or provider’s tax ID. If it appears after the 2000A or 2000B loop, it’s an enrollment issue. This error can also be caused by issues with the payer-assigned login ID and incorrect/missing portal payer credentials.
42
Unable to Respond at Current TimepayerThis is typically a temporary issue with the payer’s system, but it can also be the payer throttling your requests or an extended outage.
43
Invalid/Missing Provider IdentificationproviderThe provider’s NPI is not registered with the payer, the NPI is registered incorrectly, or the payer requires an agreement.
44
Invalid/Missing Provider NameproviderThe provider’s NPI is registered with an incorrect name at the payer. The provider must contact the payer directly to remedy this issue, due to PHI/HIPAA guidelines.
45
Invalid/Missing Provider SpecialtyproviderThe provider’s NPI is not registered with the payer under the correct specialty. The provider must contact payer directly to remedy this issue, due to PHI/HIPAA guidelines.
46
Invalid/Missing Provider Phone NumberproviderThe provider’s phone does not match what is registered with the payer or the NPPES system for this provider. The provider must contact the payer directly to remedy this issue, due to PHI/HIPAA guidelines.
47
Invalid/Missing Provider StateproviderThe provider’s address does not match what is listed with the payer or the NPPES system. The provider must contact the payer directly to remedy this issue, due to PHI/HIPAA guidelines.
48
Invalid/Missing Referring Provider Identification NumberproviderThe referring provider’s NPI is not registered with the payer’s plans; the provider must contact the payer directly. Or, the enrollment is incorrect; contact Stedi support.
50
Provider Ineligible for InquiriesproviderThe provider is not registered for that service type with the payer. The provider must contact the payer directly.
51
Provider Not on FileproviderThe provider is not registered with the payer. The provider must contact payer directly to register their NPI.
52
Service Dates Not Within Provider Plan EnrollmentproviderThe provider was not registered in the insured’s plan with the payer on the Date-of-Service (DOS) listed in the transaction.
53
Inquired Benefit Inconsistent with Provider TypeproviderThe provider submitted a transaction for a specialty that they are not registered with the payer to perform.
54
Inappropriate Product/Service ID QualifierproviderInvalid ID qualifier.
55
Inappropriate Product/Service IDproviderInvalid procedure code.
56
Inappropriate Dateprovider, subscriber, or dependentsIncorrect date or incorrect date format used.
57
Invalid/Missing Date or Serviceprovider, subscriber, or dependentsThe date-of-service (DOS) is not within the allowable timeframe, the DOS is not included in the request (but may be required), or the DOS is in the future.
58
Invalid/missing Date-of-birth (DOB)subscriber or dependentsThe date-of-birth (DOB) was not included in the request and the payer requires it to locate the member, or the DOB was improperly formatted.
60
DOB Follows DOSprovider, subscriber, or dependentsThe date-of-service (DOS) is before the date-of-birth (DOB). In this case, the transaction should be submitted with the mother’s information.
61
Date of Death (DOD) Precedes DOSprovider, subscriber, or dependentsThe insured died before date-of-service (DOS) listed in the transaction. The provider must correct and resubmit.
62
Date-of-service (DOS) Not Within Allowable Inquiry Periodprovider, subscriber, or dependentsThe date-of-service (DOS) is outside of the accepted time frame for requests to be submitted for the payer.
63
Date-of-service (DOS) in the futureprovider, subscriber, or dependentsSome payers do not accept the date-of-service (DOS) in the future. Check the payer’s specifications.
64
Invalid/Missing Patient IDdependentsA patient ID was missing from the request (and may be required), or the patient ID was incorrect in the request and needs to be verified with a copy of the insurance card.
65
Invalid/Missing Patient NamedependentsA patient name was not included (but may be required), or the patient name is spelled differently in the payer database than the provider entered into the request.
66
Invalid/Missing Patient Gender CodedependentsThe gender type code is invalid/missing, or the patient is invalid/missing from the payer’s database.
67
Patient Not FounddependentsThe patient is not in the payer’s database, or the patient is not included in the data file used for hosting.
68
Duplicate Patient ID NumberdependentsThere is either a different patient with the same member ID in the payer’s database or in the hosted data file.
69
Inconsistent with Patient’s AgeproviderThe diagnosis codes are inconsistent with patient’s age.
70
Inconsistent with Patient’s GenderproviderThe procedure codes are inconsistent with the patient’s gender.
71
Patient DOB Does Not Match That for the Patient on the Databasesubscriber or dependentsThe date-of-birth (DOB) sent in the request does not match that in the payer’s database.
72
Invalid/Missing Subscriber/Insured IDsubscriberThe subscriber member ID was incorrect in the request, the request does not meet the payer’s requirements for the subscriber ID, or there is another unidentified error in the request data.
73
Invalid/Missing Subscriber/Insured NamesubscriberAn incorrect subscriber name was submitted, the subscriber name is missing, the subscriber name is spelled incorrectly, or the request is not meeting the payer’s requirements for the subscriber name.
74
Invalid/Missing Subscriber/Insured Gender CodesubscriberThe subscriber’s gender code was not submitted, an invalid character was provided, or an incorrect gender code was provided.
75
Subscriber/Insured Not FoundsubscriberThe subscriber was not found.
76
Duplicate Subscriber/Insured ID NumbersubscriberA duplicate member ID was found in the payer’s database.
77
Subscriber Found: Patient Not FounddependentThe subscriber was found in the payer’s database but the dependent’s information is not in the payer’s database.
78
Subscriber/Insured Not in Group/Plan identifiedsubscriber
79
Invalid Participant Identificationpayer or providerThe NPI in the request is not on file with the payer.
80
No Response received - Transaction TerminatedpayerThe payer had a processing issue, or the transaction timed out.
T4
Payer Name or Identifier MissingpayerThe payer ID submitted was incorrect/invalid, or the payer had a processing issue.