Introducing Stedi’s Batch Eligibility Check API

Many providers need to perform batch eligibility checks for patients monthly or before upcoming appointments. These refresh or background checks have historically required significant development effort.

First, you need complex logic to avoid payer concurrency constraints; payers can throttle requests or even block the NPI when providers send too many checks at once. Then, you need a robust way to detect payer outages and manage retries. Finally, you need to monitor your clearinghouse concurrency ‘budget’ to ensure you have enough throughput left for time-sensitive real-time checks. 

Stedi’s new Batch Eligibility Check API handles all of this complexity for you. You can submit millions of eligibility checks – up to 500 per batch request – for Stedi to process asynchronously. Stedi manages throughput and retries automatically using industry best practices. Even better, asynchronous checks don’t count toward your Stedi account’s concurrency limits, so you can stage an unlimited number of batch checks while continuing to send real-time checks in parallel.

Under the hood, Stedi’s Batch Eligibility Check API uses the same real-time EDI rails as our normal Eligibility Check API, which means that our batch eligibility check jobs aren’t subject to the delays commonly found in other batch eligibility offerings.

Automate batch eligibility checks with two simple endpoints

You can automate asynchronous batch checks to thousands of payers by calling Stedi’s Batch Eligibility Check endpoint with a JSON payload. You may want to submit batch requests for:

• All patients at the beginning of every month to identify those who have lost or changed coverage.

• Patients with upcoming appointments to identify those who no longer have active coverage. 

• New claims before they are submitted, to ensure they are routed to the correct payer.

Once you submit a batch, Stedi translates the JSON into compliant X12 270 payloads and delivers them to the designated payers as quickly as possible using Stedi’s master payer connections. You can then use the Poll Batch Eligibility Checks endpoint to retrieve the results for completed checks. Stedi automatically handles payer downtime and retries requests as needed.

The following example request demonstrates how to submit a batch of eligibility checks, where each item in the array represents an individual check. The request format is the same as our Real-Time Eligibility Check endpoint, with the addition of the submitterTransactionIdentifier property, a unique identifier you can use to match each check to the payer’s response.

curl --request POST \
  --url https://manager.us.stedi.com/2024-09-01/eligibility-manager/batch-eligibility \
  --header 'Authorization: <api-key>' \
  --header 'Content-Type: application/json' \
  --data '{
  "items": [
    {
      "submitterTransactionIdentifier": "ABC123456789",
      "controlNumber": "000022222",
      "tradingPartnerServiceId": "AHS",
      "encounter": {
        "serviceTypeCodes": [
          "MH"
        ]
      },
      "provider": {
        "organizationName": "ACME Health Services",
        "npi": "1234567891"
      },
      "subscriber": {
        "dateOfBirth": "19000101",
        "firstName": "Jane",
        "lastName": "Doe",
        "memberId": "1234567890"
      }
    },
    {
      "submitterTransactionIdentifier": "DEF123456799",
      "controlNumber": "333344444",
      "tradingPartnerServiceId": "AHS",
      "encounter": {
        "serviceTypeCodes": [
          "78"
        ]
      },
      "provider": {
        "organizationName": "ACME Health Services",
        "npi": "1234567891"
      },
      "subscriber": {
        "dateOfBirth": "19001021",
        "firstName": "John",
        "lastName": "Doe",
        "memberId": "1234567892"
      }
    }
  ]
}'

Minimize payer throttling through industry best practices

Stedi processes batch eligibility checks as quickly as possible while implementing best practices to avoid payer throttling, such as:

• Observing NPI throughput limits in real time and adjusting the rate of requests accordingly.

• Interleaving requests to multiple payers in a round-robin style to avoid hitting a payer with the same provider NPI too many times consecutively. For example, instead of sending all requests to payer #1 and then all requests to payer #2, Stedi will send one request to payer #1, then one request to payer #2, and then go back to payer #1.

• Using backoff algorithms and other strategies when retrying requests to the same payer.

We continually incorporate our learnings about individual payer requirements and behavior into the system to ensure the most efficient batch processing time. 

Detect payer downtime and automatically retry

Stedi supports a growing list of payers for eligibility checks and continually monitors payer uptime. 

When Stedi detects a payer outage, our APIs reroute requests through alternate direct-to-payer or peer clearinghouse connections if possible. When requests fail due to payer processing issues, Stedi implements a retry strategy based on best practices and each payer’s connectivity requirements.

Start processing eligibility checks with Stedi

With Stedi’s Real-Time Eligibility Check and Batch Eligibility Check APIs, you can start automating eligibility checks for your organization today. 

Contact us to learn more and speak to the team.