Eligibility report is not working
Common Eligibility Error Messages
"Unable to respond at current time":
Indicates that the payer's real-time eligibility service failed to send usable data to the clearinghouse at the time of the request.
The issue is typically temporary and resolves by retrying later.
"A valid eligibility response was not returned":
Highlights that the payer was unable to return a usable eligibility payload.
Retrying later or taking further action after several days may be necessary.
Step-by-Step Troubleshooting Guide
Retry the Check:
Wait and retry the automated eligibility check later the same day or the next day.
Verify Payer Configuration:
Ensure the payer supports real-time eligibility.
Confirm that the Eligibility Payer ID matches exactly with the clearinghouse’s payer list.
Manually Verify Coverage:
Use the payer's portal to manually check coverage.
Manually mark the policy as "Active" in urgent cases.
Escalate if Unresolved:
If unresolved, follow your escalation process with the clearinghouse after three days.
You should be able to click on any of the reports to open and view the report.
When to Escalate the Issue
Persistent eligibility problems require clearinghouse investigation. Work with internal billing teams or designated contacts for effective resolution.
Patient is eligible, but it shows Inactive.
The most common reason for this issue is that this payer does not support real time eligibility and it must be checked through the payer's portal directly. You can still record a manual eligibility check in the system.
If this is the error, you will see that the type of eligibility report is ERROR, and if you click to view you will see the message that this payer ID does not support electronic checks.
