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Eligibility Errors - Coggle Diagram
Eligibility Errors
Eligibility Response Errors
(are received in the Eligibility Response
and viewed in the Eligibility Report)
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61,863 62 Date of Service Not Within Allowable Inquiry Period
Important:
The TIMING of the request is the root issue.
The request needs to be made when the payor can accept it.
Messaging:
insuranceCompany does not process eligibility requests made on mm/dd/yy for the date of service of mm/dd/yy.
The request date (mm/dd/yy) is outside of their allowable period for the date of service (mm/dd/yy).
Background
Typically, payers are required to provide eligibility information for up to twelve months in the past and forward to the end of this month.
Action:
Make another request later at a time when the payer can process it.
This may require learning the payer's rules for accepting eligibility requests.
56,880 42 Unable to Respond at Current Time
24,158 71 Patient Birth Date Does Not Match That for the Patient on the Database
22,095 65 Invalid/Missing Patient Name
20,702 64 Invalid/Missing Patient ID
17,468 72 Invalid/Missing Subscriber/Insured ID
16,509 73 Invalid/Missing Subscriber/Insured Name
8,776 80 No Response received - Transaction Terminated
4,095 63 Date of Service in Future
3,766 79 Invalid Participant Identification
3,618 67 Patient Not Found
3,068 78 Subscriber/Insured Not in Group/Plan Identified
2,605 75 Subscriber/Insured Not Found
2,362 43 Invalid/Missing Provider Identification
1,268 50 Provider Ineligible for Inquiries
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373 77 Subscriber Found, Patient Not Found
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