Eligibility Manager

Eligibility Manager provides insight into your eligibility check pipeline and helps you identify, diagnose, and fix failed eligibility checks. For example, you can filter for all of the eligibility checks that failed during a payer outage and retry once the payer is back online.

In the app, you can:

• Review every eligibility check you submit through the app or Stedi’s APIs.
• Search and filter historical eligibility checks by status, Payer ID, date, and error code.
• Edit and retry failed eligibility checks and review the details of each attempt.
• Use the Debug view to systematically troubleshoot failed eligibility checks until you receive a successful response from the payer.

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Example troubleshooting workflow

The following example shows how Eligibility Manager can help you track and resolve eligibility check failures:

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Eligibility search

Eligibility Manager stores eligibility check requests in groups called eligibility searches. An eligibility search is a chronological record of every eligibility check submitted with the same Eligibility Search ID.

When you submit an eligibility check through the app or API, Stedi creates a new eligibility search record based on the Eligibility Search ID assigned to the request. Every time you retry that eligibility check with the same Eligibility Search ID, Stedi stores the retry details within the existing eligibility search. This creates a clear timeline of troubleshooting efforts for failed requests.

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Create

You can create a new eligibility search through the app or Stedi’s APIs.

• App: Click New search and enter the eligibility check details into the interactive form.
• API: Use the Eligibility Check API to submit an eligibility check programmatically.

For both methods, you can either set a unique Eligibility Search ID for the request, or Stedi can automatically assign one for you. Once you submit the eligibility check, Stedi creates a new eligibility search in the app.

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External Patient ID

You can optionally add a External Patient ID to the request. This should be a unique identifier for the patient in your system. Adding this identifier helps you identify eligibility checks for the same patient over time.

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Filter

You can filter eligibility searches by the following criteria:

• Error code: By the AAA code returned by the payer. For example, 42 errors indicate a connectivity issue.
• Payer: By the Payer ID (62308) or business name (such as Cigna)
• Status: By Queued, Started, Failed, Inactive, and Active
• Date: A date range for when the initial eligibility check within an eligibility search was submitted. For example, a filter beginning on October 1st would only include eligibility searches with an initial submission on or after October 1st. It would not include an eligibility search with an initial submission on September 30th and a retry on October 1st.
• Available actions: Immediately find all eligibility searches that are eligible to edit and retry (errors in the request data) or retry without edits (error codes 42 and 80, which indicate payer connectivity issues).

Results are sorted by the date of the original eligibility check within the eligibility search, with the most recent listed first.

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Statuses

The status of an eligibility search is determined by the most recent eligibility check in the record. For example, if the most recent iteration of a check failed, the status of the entire eligibility search is Failed, even if a previous version of the request succeeded.

An eligibility search can have one of the following statuses:

• Queued: Stedi placed the eligibility check in its internal queue and will send it to the payer when resources are available. This status is common when you schedule batch eligibility check refreshes through the API or perform large bulk retries that exceed your account’s concurrency budget. You can typically expect the status to change to Started within a few seconds.
• Started: Stedi sent your eligibility check to the payer and is waiting for a response.
• Failed: The payer returned an error code in the response. Review the error code and retry the eligibility check.
• Inactive: The payer’s response doesn’t contain an active eligibility and benefit type.
• Active: The payer’s response contains an active eligibility and benefit type (codes 1-5). Visit Eligibility and benefit type codes for a complete list.

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Retry failed eligibility checks

Eligibility Manager allows you to edit the request details and retry eligibility checks until you get a successful response. You can choose to retry the entire eligibility search (the most recent iteration of the eligibility check) or select a specific iteration to retry.

To resubmit an eligibility check, click an eligibility search to review its details and then click Edit and retry.

Stedi opens a submission form prepopulated with the request details from the iteration you selected. You can update the patient information, service type codes, and other properties as needed, and then click Submit to retry the eligibility check.

You’ll know the retry was successful when the status of the eligibility search is either Active or Inactive. Once a retry is successful, you can view the raw request data for the successful check and use it to make a call to Stedi’s Eligibility Check API.

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Debug view

Click Debug within an eligibility search to enter 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.

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Batch retry

Error codes 42 and 80 indicate that an eligibility check failed because of a connectivity issue between Stedi and the payer. Common causes include payer outages, payer throttling, and that the transaction timed out. Visit Eligibility troubleshooting for complete details.

You can filter for all eligibility searches with error codes 42 and 80 by selecting Available actions: Retry. Then, you can perform a batch retry for up to 50 failed requests at a time. This action automatically resubmits the most recent eligibility check within each eligibility search.

This approach is useful when you need to retry multiple eligibility checks that failed during a payer outage. Visit Stedi’s Payer Status page to review the current and historical uptime for supported payers and subscribe to outage notifications.