Troubleshoot failed eligibility checks

You can edit the request details for failed eligibility checks and resubmit them as many times as you need to get a successful response. For some types of errors, you can use the Stedi Agent to troubleshoot automatically.

Review eligibility check errors

The Eligibility check errors page shows a list of all the recent eligibility check error codes.

The errors are grouped by error code, and you can filter the list by Payer ID. You can look up any payer's ID in the Payer Network. Click on an error code to review a list of all the instances of that particular error.

This page helps you identify patterns in eligibility check failures. For example, if you see a large number of errors with code 75 (Subscriber/Insured Not Found) for a specific payer, you might want to investigate whether there are common issues with the patient data being submitted to that payer.

Retry failed eligibility checks

There are three ways to retry a failed eligibility check: using the Stedi Agent, manually resubmitting the request, or using Debug view.

Retry with the Stedi Agent

The Stedi Agent can troubleshoot and resolve common recoverable eligibility check errors automatically. To use it, you must be at least an Operator role within your Stedi account.

To resolve a failure with the Stedi Agent:

1. Go to the Eligibility searches page.
2. Click Resolve with Stedi Agent next to an eligibility search. The button appears when you hover over the green agent indicator. Only eligibility search with common recoverable errors will have the agent indicator next to them. If an eligibility search doesn't have this symbol, you'll need to retry it manually.
3. The Stedi Agent opens a side panel in Debug view.
4. The Stedi Agent analyzes the eligibility request and works through best practice recovery strategies based on the error type. For example, if the payer returned an error code 75 (Subscriber/Insured Not Found), the agent may try different combinations of patient data or adjust the name format to find a match in the payer's system.

Each time the agent retries the eligibility check, it stores the new request in the same eligibility search record and it shows up in Debug view in real time. This allows you to see the history of attempts and the progression of the agent's troubleshooting efforts.

The agent only accesses data from the eligibility search it's working on. It can't access data from other searches, customers, or systems.

Please note:

• The Stedi Agent is available on all paid Stedi plans at no additional cost beyond those for related API calls.
• The agent is assistive. Outputs can be incorrect or incomplete. Verify all responses before taking any action based on them.
• You are responsible for any actions you instruct or authorize the AI service to take, including generating billable requests on your behalf.

Manually edit and retry

To manually resubmit an eligibility check:

1. Go to the Eligibility searches page.
2. Click the eligibility search you want to troubleshoot to view its details.
3. Click Actions and then select Edit and retry.
4. Update the request details as needed, and click Submit.

You'll know the retry was successful when the status of the eligibility search is either Active or Inactive. If the status of the eligibility search is still Failed, you may want to try resolving in Debug view or using the Stedi Agent, if available.

Iterate in Debug view

Debug view is a workspace where you can systematically troubleshoot failed eligibility checks until you receive a successful response from the payer. For example, first you might try swapping the patient's nickname (Dave) for their full name (David) to see if that returns benefits information. In the next iteration, you might try submitting the request with a different service type code or dropping the date of birth.

Debug view shows all past iterations of the eligibility check and highlights the differences between each new version of the request. You can also draft and submit new requests directly from this page. This format helps you understand what you've already tried and quickly iterate on failed requests.

To troubleshoot eligibility checks in Debug view:

1. Go to the Eligibility searches page.
2. Click the eligibility search you want to troubleshoot to view its details.
3. Click Actions > Debug to enter Debug view.
4. Click + Add draft to create a new draft request. Stedi pre-populates the draft with the details from the most recent eligibility check in the search.
5. Update the draft request as needed. Use the Edit columns list to show or hide specific fields in the request.
6. Click the green arrow when you're ready to submit the updated eligibility check draft.

Stedi runs the check and moves it to the list of Past checks. Stedi highlights the differences between it and other past checks so you can see a clear record of your troubleshooting efforts. You can repeat this process as many times as needed to get a successful response.

Payer unable to find patient

Sometimes, a payer can't return benefits information for a patient even when the patient exists in their system. This problem can occur for a couple reasons.

Multiple matching records

Payers can have multiple records of patients with the same name and date of birth. The payer cannot return benefits information unless they are able to identify a unique match within their system.

To avoid this issue, we recommend:

• Include all of the demographic information available for a patient.
• Include the patient's member ID, if available.

Information discrepancies

There can be discrepancies between the information the provider has collected from the patient and the record the payer has in their system. These discrepancies can lead to issues returning a patient, even though a match exists. Some examples include differences in spelling the patient's name, using a nickname instead of the full name ("Nick" vs. "Nicolas"), and accidentally transposing numbers in the date of birth.

If a request fails to return the expected member in the response, we recommend progressively sending additional eligibility check requests with fewer patient identity and demographic data elements, or different combinations of those. This allows you to identify and handle cases where there are data errors or discrepancies between payer and provider data.

Name mismatches

If the payer fails to find a matching plan member due to a name mismatch, the errors array in the response typically has the code set to one of the following values:

• 65: Invalid/Missing Patient Name
• 67: Patient Not Found
• 73: Invalid/Missing Subscriber/Insured Name
• 75: Subscriber/Insured Not Found

These error codes are set by the payer, not by Stedi, so it's possible that other error codes could be returned.

Resolving the error may require trying different name variations until the check is successful.

• Replace any nickname or shortened name with the full legal name, for example "Robert" instead of "Bob".
• Replace any non-English or accented characters (letters with diacritical marks) such as "Ñ" or "é" with the closest equivalent within the character restrictions. Stedi automatically replaces most such characters with the usual closest equivalent but this might not match the payer's record. For example, the character "Đ" could be transliterated to "D" or "J" depending on the romanization system used.
• For compound names try using only one or the other part. You can also try try removing the separator, or changing the separator from hyphen to space, or vice versa. Some payers may ignore special or separator characters when performing name searches.
• If the patient has recently changed their name, for example due to marriage, then the name stated by the patient or printed on their ID card might not match the payer's record. Try both the current and previous name.