> ## Documentation Index > Fetch the complete documentation index at: https://stedi.com/docs/llms.txt > Use this file to discover all available pages before exploring further. # Eligibility troubleshooting A list of potential errors and possible resolutions when submitting 270/271 eligibility checks. ## 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. ## Retry strategy Implementing the right retry strategy for eligibility check failures saves a lot of time and money. At a minimum, we **strongly recommend** automatically retrying every request that fails due to payer connectivity issues. Automatic retries resolve a significant portion of these types of failures without manual intervention. ### Payer connectivity issues We recommend implementing automatic retries for all of the following [`AAA` error](/healthcare/eligibility-troubleshooting#payer-aaa-errors) cases. These scenarios indicate temporary payer downtime, throttling, or intermittent connectivity issues: * `42` (Unable to Respond at Current Time) * `42` (Unable to Respond at Current Time) and `79` (Invalid Participant Identification) * `80` (No Response received - Transaction Terminated) Our recommended retry strategy depends on your eligibility check workflow. #### Real-time eligibility checks For real-time eligibility checks that require a response within a few minutes, we recommend: * Wait 15 seconds before the first retry. * Then, retry every 15 seconds for up to 2 minutes. The recommended retry window is based on what's acceptable in real-time human workflows. For example, a patient checking in for an appointment at their doctor's office. * Don't hit the payer with the same NPI ID more than once every 15 seconds. This time between requests helps you avoid payer throttling. * If the request is still unsuccessful, fail gracefully and escalate as needed. #### Scheduled eligibility checks You may want to run scheduled or background eligibility checks to perform periodic refreshes for a patient population or when checking eligibility for upcoming appointments. If you're using the [Batch Eligibility Check](/api-reference/healthcare/post-healthcare-batch-eligibility) endpoint (recommended), Stedi automatically retries checks that fail due to payer connectivity issues for up to 8 hours. If you're submitting real-time checks that can tolerate longer wait times, we recommend: * Wait 1 minute to perform the first retry. * Then, exponentially increase the wait between subsequent retries to up to 30 minutes between attempts. * We recommend retrying for at least 8 hours, but the retry window should be based on your business workflows. ### Other common error cases You should also consider the following common error cases when implementing retries: | AAA error | HTTP status | Reason | Retry Strategy | | --------- | ----------- | ---------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | | - | `429` | You exceeded your Stedi concurrency limit. | Retry immediately. Monitor your open concurrent requests and immediately replace any finished requests under your Stedi account limit. | | `79` | `200` | Stedi successfully sent your request to the payer, but the payer rejected it. | First, retry as soon as possible with a different member and a different [NPI](/healthcare/national-provider-identifier). This helps determine whether the issue is with the original request or there is a broader issue with the payer. If you determine the issue is with the payer, follow our guidance for [payer connectivity issues](#payer-connectivity-issues). | | `79` | `400` | Either Stedi doesn't recognize the payer ID you provided, or the payer is not configured for eligibility checks. | **Don't automatically retry.** Fix the payer ID or contact Stedi support to resolve. | ## Errors You may encounter the following types of errors when submitting eligibility requests. ### Stedi payer errors Stedi returns errors when it encounters issues with the payer ID you provided. | Error message | Possible 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](https://www.stedi.com/healthcare/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 error resulted from an unrecognized payer ID: {/* schema:EligibilityCheckResponseContent */} ```json { "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" } ``` ### 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: {/* schema:EligibilityCheckResponseContent */} ```json { "controlNumber": "123456789", "tradingPartnerServiceId": "CIGNA", "errors": [ { "code": "33", "description": "Input Errors", "followupAction": "Please Correct and Resubmit", "possibleResolutions": "Missing required field: provider" } ], "status": "ERROR" } ``` ### Payer AAA errors When a payer rejects your eligibility check, the 271 response contains one or more [`AAA` Request Validation segments](https://portal.stedi.com/app/guides/view/hipaa/health-care-eligibility-benefit-response-x279a1/01GS66YHZPB37ABF34DBPSR213#properties.detail.properties.information_source_level_HL_loop.items.properties.request_validation_AAA) 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](/healthcare/send-eligibility-checks#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 `followupAction`: * Please Correct and Resubmit * Resubmission Not Allowed | Note that this code doesn't mean you should never resubmit the request. Intermediary clearinghouses may send this code when they have temporarily lost connection to the payer, so this code indicates that you should wait at least a few minutes before retrying instead of retrying immediately. * Resubmission Allowed * Do Not Resubmit; Inquiry Initiated to a Third Party | This code is uncommon * Please Resubmit Original Transaction * Please Wait 30 Days and Resubmit | This code is uncommon * Please Wait 10 Days and Resubmit | This code is uncommon * Do not resubmit; We Will Hold Your Request and Respond Again Shortly | This code is uncommon 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`): {/* schema:EligibilityCheckResponseContent */} ```json { "subscriber": { "memberId": "123456789", "firstName": "JANE", "lastName": "DOE", "entityIdentifier": "Insured or Subscriber", "entityType": "Person", "dateOfBirth": "19001103", "aaaErrors": [ { "field": "AAA", "code": "75", "description": "Subscriber/Insured Not Found", "followupAction": "Please Correct and Resubmit", "location": "Loop 2100C", "possibleResolutions": "- Subscriber was not found." } ] } } ``` However, all errors at the `payer`, `provider`, `subscriber`, and `dependents` levels are also reported in the top-level `errors` array in the eligibility check response. Visit [Eligibility mock requests](/api-reference/healthcare/mock-requests-eligibility-checks) to retrieve more examples of common AAA errors in eligibility responses. #### Payer You may receive the following types of errors at the `payer` level. | Code | Description | Possible causes and resolutions | | ---- | --------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | 04 | Authorized Quantity Exceeded | Too many patients sent in the request. | | 41 | Authorization/Access Restrictions | | | 42 | Unable to Respond at Current Time | This is typically a temporary issue with the payer's system, but it can also be an extended outage. | | 79 | Invalid Participant Identification | There is a problem connecting with this payer. Contact Stedi support. | | 80 | No Response received - Transaction Terminated | | | T4 | Payer Name or Identifier Missing | | #### Provider You may receive the following types of errors at the `provider` level. | Code | Description | Possible causes and resolutions | | ---- | -------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | 15 | Required application data missing | The request is missing required provider additional identification in `informationReceiverName`. | | 41 | Authorization/Access Restrictions | | | 43 | Invalid/Missing Provider Identification | | | 44 | Invalid/Missing Provider Name | Provider's [NPI](/healthcare/national-provider-identifier) is registered with incorrect name at the payer. Provider must contact the payer directly to have this issue fixed because of PHI/HIPAA guidelines. | | 45 | Invalid/Missing Provider Specialty | The provider's [NPI](/healthcare/national-provider-identifier) not registered with payer under correct specialty. Provider must contact payer directly to remedy this issue, due to PHI/HIPAA guidelines. | | 46 | Invalid/Missing Provider Phone Number | Provider's phone does not match what is registered with the payer or NPPES system for this provider. Provider must contact the payer directly to remedy this issue, due to PHI/HIPAA guidelines. | | 47 | Invalid/Missing Provider State | The provider's address does not match what is listed with the payer or the NPPES system. Provider must contact the payer directly to remedy this issue, due to PHI/HIPAA guidelines. | | 48 | Invalid/Missing Referring Provider Identification Number | | | 50 | Provider Ineligible for Inquiries | The provider is not registered for that service type with payer; provider must contact payer directly. | | 51 | Provider Not on File | Provider is not registered with the payer; provider must contact payer directly to register their [NPI](/healthcare/national-provider-identifier). | | 79 | Invalid Participant Identification | There is a problem connecting with this payer. Contact Stedi support. | | 97 | Invalid or Missing Provider Address | The provider address sent in `informationReceiverName.address` was missing or invalid. | | T4 | Invalid or Missing Provider Address | | #### Subscriber You may receive the following types of errors at the `subscriber` level. | Code | Description | Possible causes and resolutions | | ---- | ---------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | 15 | Required application data missing | Subscriber info may not contain enough data to complete a benefits search. Review the payer requirements in the payer's companion guide and resubmit. | | 33 | Input Errors | | | 35 | Out of Network | The subscriber is not in the provider's network. | | 42 | Unable to Respond at Current Time | This is typically a temporary issue with the payer's system, but it can also be an extended outage or the payer is [throttling your requests](https://www.stedi.com/docs/healthcare/send-eligibility-checks#avoid-payer-throttling). | | 43 | Invalid/Missing Provider Identification | | | 45 | Invalid/Missing Provider Specialty | Provider's [NPI](/healthcare/national-provider-identifier) not registered with the payer under correct specialty. | | 47 | Invalid/Missing Provider State | Provider's address does not match what is listed with the payer or the NPPES system. Provider must contact payer directly to remedy this issue, due to PHI/HIPAA guidelines. | | 48 | Invalid/Missing Referring Provider Identification Number | | | 49 | Provider is Not Primary Care Physician | The payer doesn’t list the provider as a PCP but requires them to be one. Either the provider or the member must contact the payer to update their record before resubmitting. | | 51 | Provider Not on File | Provider is not registered with the payer; provider must contact payer directly to register their [NPI](/healthcare/national-provider-identifier). | | 52 | Service Dates Not Within Provider Plan Enrollment | Provider was not registered in the insured's plan with the payer on the Date-of-Service (DOS) listed in transaction. | | 53 | Inquired Benefit Inconsistent with Provider Type Enrollment | Provider submitting a transaction for specialty that they are not registered with the payer to perform. | | 54 | Inappropriate Product/Service ID Qualifier | Invalid procedure code qualifier. Update the request and resubmit. | | 55 | Inappropriate Product/Service ID | Invalid procedure code. | | 56 | Inappropriate Date | Incorrect date or incorrect date format. | | 57 | Invalid/Missing Date(s) of Service | | | 58 | Invalid/Missing Date-of-Birth | DOB was not sent in the request and is required by the payer to locate the member. | | 60 | Date of Birth Follows Date(s) of Service | Date-of-service (DOS) is before the DOB in which case; the transaction should be submitted with the mother's information. | | 61 | Date of Death Precedes Date(s) of Service | Insured died before Date-of-service (DOS) listed in the transaction; provider must correct and resubmit. | | 62 | Date of Service Not Within Allowable Inquiry Period | Date-of-service (DOS) is outside of the accepted time frame for requests to be submitted for the payer. | | 63 | Date of Service in Future | Some payers do not accept Date-of-service (DOS) in the future; check payer specifications. | | 69 | Inconsistent with Patient’s Age | Diagnosis codes are inconsistent with patient's age. | | 70 | Inconsistent with Patient’s Gender | Procedure codes are inconsistent with patient's gender. | | 71 | Patient Birth Date Does Not Match That for the Patient on the Database | DOB sent in request does not match that in the payer's database. | | 72 | Invalid/Missing Subscriber/Insured ID | | | 73 | Invalid/Missing Subscriber/Insured Name | | | 74 | Invalid/Missing Subscriber/Insured Gender Code | | | 75 | Subscriber/Insured Not Found | Subscriber was not found. Try sending a request with `firstName`, `lastName`, `dateOfBirth`, and `memberId`. | | 76 | Duplicate Subscriber/Insured ID Number | A duplicate member ID was found in the payer's database. | | 78 | Subscriber/Insured Not in Group/Plan identified | Verify subscriber's group number and resubmit. | | 98 | Experimental Service or Procedure | | | Aa | Authorization Number Not Found | The `priorAuthorizationNumber` sent in the request was not found. | | AE | Requires Primary Care Physician Authorization | Resubmit with `priorAuthorizationNumber` in the request. | | AF | Invalid/Missing Diagnosis Code(s) | Diagnosis Code(s) is invalid format or required by the payer to complete request. | | AG | Invalid/Missing Procedure Code(s) | Procedure Code(s) is invalid format or required by the payer to complete request. | | AO | Additional Patient Condition Information Required | | | CI | Certification Information Does Not Match Patient | The `priorAuthorizationNumber` was found, but does not match the member sent in the request. | | E8 | Requires Medical Review | Contact the payer for additional information. | | IA | Invalid Authorization Number Format | The `priorAuthorizationNumber` sent in the request was not formatted correctly. | | MA | Missing Authorization Number | A `referralNumber` or `priorAuthorizationNumber` has been issued but was not sent in the request. | #### Dependents You may receive the following errors at the `dependents` level. | Code | Description | Possible causes and resolutions | | ---- | --------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | 15 | Required application data missing | Dependent info may not contain enough data to complete a benefits search. Review the payer requirements in the payer's companion guide and resubmit. | | 33 | Input Errors | | | 35 | Out of Network | The dependent is not in the provider's network. | | 42 | Unable to Respond at Current Time | This is typically a temporary issue with the payer's system, but it can also be an extended outage or the payer [throttling your requests](https://www.stedi.com/docs/healthcare/send-eligibility-checks#avoid-payer-throttling). | | 43 | Invalid/Missing Provider Identification | | | 45 | Invalid/Missing Provider Specialty | Provider's [NPI](/healthcare/national-provider-identifier) not registered with the payer under correct specialty. Provider must contact payer directly to remedy this issue, due to PHI/HIPAA guidelines. | | 47 | Invalid/Missing Provider State Specialty | Provider's address does not match what is listed with the payer or the NPPES system. Provider must contact payer directly to remedy this issue, due to PHI/HIPAA guidelines. | | 48 | Invalid/Missing Referring Provider Identification Number | | | 52 | Service Dates Not Within Provider Plan Enrollment | Provider was not registered in the insured's plan with the payer on the Date-of-Service (DOS) listed in transaction. | | 51 | Provider Not on File | Provider is not registered with the payer; provider must contact payer directly to register their [NPI](/healthcare/national-provider-identifier). | | 52 | Service Dates Not Within Provider Plan Enrollment | Provider was not registered in the insured's plan with the payer on the Date-of-Service (DOS) listed in transaction. | | 53 | Inquired Benefit Inconsistent with Provider Type Enrollment | Provider submitting a transaction for specialty that they are not registered with the payer to perform. | | 54 | Inappropriate Product/Service ID Qualifier | Invalid procedure code qualifier. Update the request and resubmit. | | 55 | Inappropriate Product/Service ID | Invalid procedure code. | | 56 | Inappropriate Date | Incorrect date or incorrect date format. | | 57 | Invalid/Missing Date(s) of Service | | | 58 | Invalid/Missing Date-of-Birth | | | 60 | Date of Birth Follows Date(s) of Service | Date-of-service (DOS) is before the DOB in which case; the transaction should be submitted with the mother's information. | | 61 | Date of Death Precedes Date(s) of Service | Insured died before Date-of-service (DOS) listed in the transaction; provider must correct and resubmit. | | 62 | Date of Service Not Within Allowable Inquiry Period | Date-of-service (DOS) is outside of the accepted time frame for requests to be submitted for the payer. | | 63 | Date of Service in Future | Some payers do not accept Date-of-service (DOS) in the future; check payer specifications. | | 64 | Invalid/Missing Patient ID | | | 65 | Invalid/Missing Patient Name | | | 66 | Invalid/Missing Patient Gender Code | | | 67 | Patient Not Found | | | 68 | Duplicate Patient ID Number | There 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 Age | Diagnosis codes are inconsistent with patient's age. | | 70 | Inconsistent with Patient’s Gender | Procedure codes are inconsistent with patient's gender. | | 71 | Patient DOB Does Not Match That for the Patient on the Database | The date-of-birth (DOB) sent in the request does not match that in the payer's database. | | 77 | Subscriber Found, Patient Not Found | Subscriber was found in payer's database but the dependent's information is not in the payer's database. | | 98 | Experimental Service or Procedure | | | AA | Authorization Number Not Found | The `priorAuthorizationNumber` sent in the request was not found. | | AE | Requires Primary Care Physician Authorization | Resubmit with `priorAuthorizationNumber` in the request. | | AF | Invalid/Missing Diagnosis Code(s) | Diagnosis Code(s) is invalid format or required by the payer to complete request. | | AG | Invalid/Missing Procedure Code(s) | Procedure Code(s) is invalid format or required by the payer to complete request. | | AO | Additional Patient Condition Information Required | | | CI | Certification Information Does Not Match Patient | The `priorAuthorizationNumber` was found, but does not match the member sent in the request. | | E8 | Requires Medical Review | Contact the payer for additional information. | | IA | Invalid Authorization Number Format | The `priorAuthorizationNumber` sent in the request was not formatted correctly. | | MA | Missing Authorization Number | A `referralNumber` or `priorAuthorizationNumber` has been issued but was not sent in the request. | ### 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](#payer-aaa-errors) from the payer. To prevent these types of mistakes, Stedi automatically suppresses any string containing (80840) in the following fields: | JSON | X12 EDI | | ----------------------------------------------------- | ----------------------------------------------------- | | `subscriber.memberId` | Loop 2100C `NM109` Subscriber Primary Identifier | | Any property in `subscriber.additionalIdentification` | Loop 2100C `REF02` Subscriber Supplemental Identifier | | Any property in `dependent.additionalIdentification` | Loop 2100D `REF02` Dependent Supplemental Identifier | 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.