Real Time Eligibility Rejections and Errors
Occasionally, eligibility verification requests may result in an error, or the payer or Change Healthcare may reject your request. In these cases, you will receive an eligibility verification report with one or more error messages under the heading Eligibility Verification Request Errors.
Some of the possible error messages are described below.
- Connection timeout: An error occurred while processing your eligibility verification request. This may happen if TherapyNotes is having trouble communicating with Change Healthcare's servers to submit your request.
- Internal system error: This error results if Change Healthcare's servers are experiencing problems which would prevent your eligibility verification request from being processed.
- Subscriber member must provide a member ID: While your client's insurance Member ID is not required to submit eligibility verification requests, some payers may need this information to process your request and accurately match the client. In most cases, you can add your client's Member ID to TherapyNotes and resubmit your request.
- Out of network: The client the eligibility verification request was submitted for is not in the network of the selected provider.
- Authorization/Access restrictions: The provider selected is not authorized to submit eligibility verification requests to the payer. This error may occur if the provider's NPI is not registered.
- Unable to respond at current time: This error results if the payer is experiencing problems with their system and is unable to process your eligibility verification request.
- Provider not on file: The payer cannot find a client's eligibility and benefit information for the selected provider because they do not have record of the provider. If this error occurs, you may need to contact the payer.
- Invalid/Missing patient name: Your eligibility verification request was rejected because the payer could not find a match for the client's name.
- Patient birth date does not match that for the patient on the database: The payer was able to match the client with their records using the information provided in your eligibility verification request, but the birth date does not match. Please confirm the eligibility verification report with the client to ensure that the information you submitted was accurate.
- No response received - Transaction terminated: Your eligibility verification request was sent to the payer, but Change Healthcare didn't receive a response in a reasonable time frame. In most cases, you may try to resubmit your request later.
If you receive an error message not listed above, please contact our success team at (215) 658-4550 or firstname.lastname@example.org. You will be asked to provide your Practice Code, the transaction number of the report, and the error message(s) displayed on your report. In some cases, our success team may need to work with our development team to determine precisely where the error was reported in your eligibility verification request.
An error message may also include a recommended follow-up action. This follow-up action is displayed after a hyphen immediately following the corresponding error message.
- Please Correct and Resubmit: If corrections are required to any client or provider information that can be changed in TherapyNotes, correct the incorrect information identified in the error message and submit another eligibility verification request with the corrected information.
- Resubmission Not Allowed: Do not try submitting another eligibility verification request. If necessary, please contact the payer or contact our success team.
- Please Resubmit Original Transaction: Submit another eligibility verification request with the same information that you submitted initially. This follow-up action may be provided alongside error messages such as Unable to respond at current time.
- Resubmission Allowed: You may try submitting another eligibility verification request. If corrections are required, correct the necessary information before resubmitting. Otherwise, you may submit another eligibility verification request with the same information that you submitted initially.
- Do Not Resubmit; Inquiry Initiated to a Third Party: Either the payer or Change Healthcare has contacted a third party to collect the eligibility and benefit information for the client. This may occur if a primary payer discovers that the client also has secondary coverage. No further action is required.
- Please Wait 30 Days and Resubmit: After 30 days, submit another eligibility verification request with the same information that you submitted initially.
- Please Wait 10 Days and Resubmit: After 10 days, submit another eligibility verification request with the same information that you submitted initially.
- Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly: You will receive another eligibility report from the payer after a short time. No further action is required.