Eligibility troubleshooting

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

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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.

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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.

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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.

To avoid this issue, we recommend:

• Enter the patient’s information exactly as it appears on their insurance card, if available.
• Enter the patient’s last name and suffix in separate fields. Payers may not always parse out the suffix from the name, leading to issues with matching.

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How to fix

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.

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Stedi concurrency limit

Requests to payers typically time out at 1 minute, though Stedi can keep connections open longer than that if needed.

Our real-time eligibility check endpoint has rate limiting on a per-account basis. This limit is based on concurrent requests, not requests per second. The default rate limit is 5 concurrent requests; if you need a higher limit, reach out to Support.

Insurance payers may take up to 60 seconds to respond to a request, so your transactions per second (and thus your concurrency limit) will vary based on the payer response time. If you reach the maximum concurrency limit, Stedi rejects additional requests with a 429 HTTP code until one of your previous requests is completed. Rejected requests have the following error message:

{
  "message": "The request can't be submitted because the sender's submission has been throttled: CUSTOMER_LIMIT",
  "code": "TOO_MANY_REQUESTS",
  "eligibilitySearchId": "019249c7-e176-76b0-a46a-3aef1a519bc4"
}

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Retrying requests

Our recommended retry approach depends on the errors and HTTP status codes in the response.

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Errors

You may encounter the following types of errors when submitting eligibility requests.

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Stedi payer errors

Stedi’s API returns errors when it encounters issues with the payer ID you provided.

The following error resulted from an unrecognized payer ID:

{
  "controlNumber":"123456789",
  "tradingPartnerServiceId":"TEST2",
  "errors":[
    {
      "code":"79",
      "description":"Invalid Participant Identification","followupAction":"Please Correct and Resubmit",
      "location":"2100A",
      "possibleResolutions":"Payer TEST2 is not configured. Please check our published payer list or contact Stedi support to resolve."
      }
  ],
  "status":"ERROR"
}

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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": "Input Errors",
      "followupAction": "Please Correct and Resubmit",
      "possibleResolutions": "Missing required field: provider",
    }
  ],
  "status": "ERROR"
}

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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."
            }
        ]
    }

Visit Eligibility mock requests to retrieve more examples of common AAA errors in eligibility responses.

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Payer

You may receive the following types of errors at the payer level.

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Provider

You may receive the following types of errors at the provider level.

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Subscriber

You may receive the following types of errors at the subscriber level.

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Dependents

You may receive the following errors at the dependents level.

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Card Issuer Identifier (80840)

All health plans use (80840) as the first five digits of the Card Issuer Identifier.

This is a placeholder value used for standards compliance only, and you shouldn’t pass it in an electronic eligibility check. However, many providers and OCR systems accidentally pass (80840) in other eligibility check fields. For example, they may try to pass this value as a subscriber or dependent ID, causing an AAA rejection from the payer.

To prevent these types of mistakes, Stedi automatically suppresses any string containing (80840) in the following fields:

If the payer’s eligibility response returns an AAA error, Stedi returns the following warning:

The field {FIELD} contains the string "(80840)", which is a known 
placeholder prefix for a field that should not be provided in {FIELD}. 
We have omitted that value in the request, and the request failed. 
Please locate the correct value for {FIELD} and resubmit.

To correct this error, read the documentation for the corresponding field, locate the correct value, and resubmit the eligibility check.