# Run eligibility checks
Source: https://www.stedi.com/docs/providers/providers-eligibility-checks

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title: Run eligibility checks
sidebarTitle: Run eligibility checks
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You can run both real-time and batch 270/271 eligibility checks in your account to verify a patient's insurance coverage and benefits.

You can also run a special kind of real-time eligibility check called a Medicare Beneficiary Identifier (MBI) lookup. MBI lookups allow you to retrieve benefits information from the Centers for Medicare and Medicaid Services (CMS) when you don't know the patient's MBI.

## Real-time eligibility checks

Real-time eligibility checks provide a response in seconds. They're ideal for in-person patient visits, telehealth appointments, and other scenarios where you need immediate information about a patient's coverage.

To run a new eligibility check:

1. Go to the [Eligibility searches page](https://portal.stedi.com/app/healthcare/eligibility).
2. Click **+ New eligibility check**.
3. Enter the required information.
   * We recommend starting with the default form fields, but you can click **Select fields** to include additional information, such as dependent information or service dates. Review [basic eligibility request fields](#basic-eligibility-request-fields) for detailed instructions and tips for completing the form.
   * Choosing the right service type code (STC) or procedure code is very important for getting the best results from the payer.
     * We recommend submitting one STC per request, unless you've tested and are certain that the payer supports multiple.
     * To request general medical benefits, we recommend using STC `30` (Health Benefit Plan Coverage).
     * To request general dental benefits, we recommend using STC `35` (Dental Care).
     * When requesting benefits for specific services, you should test the STCs that seem most appropriate to determine which ones yield the most benefits information. Our docs for choosing the right [STCs and procedure codes](/providers/providers-stc-procedure-codes) explain how.
4. Click **Submit**.

Stedi runs the eligibility check and stores it in a new [eligibility search](/providers/providers-eligibility-search). Stedi automatically opens the **Eligibility search** overview page for the check.

Click **View** to see the details of the eligibility check, including a [benefits summary](/providers/providers-review-patient-benefits#benefits-tab) if the check was successful. If the check failed, you can review the error code and retry the check with updated information. Visit [Fix failed eligibility checks](/providers/providers-eligibility-troubleshooting) for instructions.

## MBI lookup

A Medicare Beneficiary Identifier (MBI) is a unique, randomly-generated identifier assigned to individuals enrolled in Medicare. You must include the patient's MBI in every eligibility check you submit to the Centers for Medicare and Medicaid Services (CMS).

When patients don't know their MBI, you can perform an MBI lookup instead of a standard eligibility check.

### Types of MBI lookups

There are two types of MBI lookups you can perform with Stedi. For each, you'll use a special payer that tells Stedi to perform an MBI lookup for the patient in addition to a standard eligibility check.

| Type     | What's required                                                    | Payer                          |
| -------- | ------------------------------------------------------------------ | ------------------------------ |
| With SSN | first name, last name, date of birth, Social Security Number (SSN) | **CMS MBI Lookup**             |
| No SSN   | first name, last name, date of birth, U.S. state                   | **CMS MBI Lookup Without SSN** |

We recommend running MBI lookups **with** the patient's SSN whenever possible. When the SSN is present, the MBI lookup has a higher likelihood of successfully returning their MBI. MBI lookups with no SSN are a fallback option when the patient's SSN isn't available.

You don't need to include more patient demographic information than what's required, such as additional address data. It doesn’t improve MBI lookup success rates.

### Run an MBI lookup

To run an MBI lookup:

1. Go to the [Eligibility searches page](https://portal.stedi.com/app/healthcare/eligibility) and click **+ New eligibility check**.

2. Construct an eligibility check request with the required patient demographic data. You don't need to include more than the required fields, such as extra address data. Extra demographic data won't improve lookup success rates.
   * **With SSN:** Include the patient's first name, last name, date of birth, and SSN.

     You'll need to click **Select fields** and check the box next to **Social Security Number (SSN)** under the **Subscriber** section. This adds the SSN field to the form.
     ![Select SSN field](/images/providers/mbi-lookup-add-ssn.png)

   * **No SSN:** Include the patient's first name, last name, date of birth, and U.S. state.

     You'll need to click **Select fields** and check the box next to **State** under the **Subscriber > Address** section. This adds the **State** field to the form. You can leave the rest of the address fields blank.
     ![Select state field](/images/providers/mbi-lookup-add-state.png)

3. Set the **Trading partner service ID** to either:
   * **CMS MBI Lookup** for MBI lookups with SSN.
   * **CMS MBI Lookup Without SSN** for MBI lookups without SSN.

4. Enter the rest of the required information. Review [basic eligibility request fields](#basic-eligibility-request-fields) for detailed instructions about how to complete the **Provider** and **Encounter** sections.

5. Click **Submit**.

Stedi uses the patient's demographic data and SSN to perform an MBI lookup. If there is a match, Stedi submits an eligibility check to CMS. Stedi returns a complete eligibility response from CMS for the patient and returns the patient's MBI as the subscriber's member ID.

Stedi automatically opens the **Eligibility search** overview page for the MBI lookup when it's complete.

<Tip>
  Medicare Advantage plans have their own unique member ID, which **isn't** returned in the MBI lookup response. You also shouldn't submit eligibility checks for Medicare Advantage plans to CMS (HETS) - you should submit them to the actual Medicare Advantage plan payer instead.
</Tip>

## Batch eligibility checks

We recommend using batch checks for bulk workflows that aren't time sensitive, such as monthly or weekly eligibility refreshes. You can submit batch eligibility checks through bulk CSV upload.

### Create new CSV batch

To create a new CSV batch:

1. Go to the [Batch eligibility checks page](https://portal.stedi.com/app/healthcare/checks/batch).
2. Click **+ New batch from CSV**.
3. Enter a unique name for the batch. Stedi displays this name in the list of batch uploads. This name is for your reference only - we don't send it to payers.
4. (Optional) Click **Advanced options** to configure a custom **Retry duration** between 8 and 24 hours. This is the maximum number of hours that Stedi will retry checks in the batch that fail due to payer connectivity issues. The default is 8 hours.
5. Click **Create** to go to the CSV upload page for your new batch.

### Upload CSV file

On the CSV upload page for your batch:

1. Click **Download a template** to download the CSV template with the supported fields. You can also download it from this link: [template CSV file](/files/batch-eligibility-template.csv).
2. Populate the template with eligibility checks. Each row in the template represents one eligibility check. You can submit up to 10,000 checks per CSV file. The upload page contains detailed documentation for each possible field and recommendations for which fields to include for the best chance of success.
3. Click **+ Upload file** to upload your complete CSV file.
4. Click **Verify file** so Stedi can validate the data in each eligibility check. You can fix any errors and re-upload the CSV file as many times as needed. When the file is error-free, you'll be able to execute the batch.
5. Click **Execute batch** to send the eligibility checks to Stedi for processing.

Stedi begins processing the batch. Each eligibility check in the batch is stored in its own eligibility search. You can review the details of each check from the [Eligibility searches page](https://portal.stedi.com/app/healthcare/eligibility).

### Review batch progress

You can review the progress of submitted batches on the [Batch eligibility checks page](https://portal.stedi.com/app/healthcare/checks/batch). The page displays each CSV batch you've submitted, along with it's name, date created, status, and total items (number of eligibility checks in the batch).

* The batch status changes to **In progress** while Stedi is processing the batch.
* The batch status changes to **Completed** when Stedi has sent all checks in the batch to payers and received responses.
* Most batches complete in 15 to 30 minutes. However, Stedi retries checks that fail due to payer connectivity issues for up to the configured retry period, so it can take up to the end of the retry period for all checks in a batch to return results.

Click a batch to view its details, including the status of each check in the batch. Click any eligibility check to go to its details page.

From the batch details page, you can also download the original CSV input by clicking **Download** under **Original input file**.

## Basic eligibility request fields

For the best chance of success, start by sending the smallest possible set of fields in your eligibility checks. Adding extra data can lead to unnecessary rejections.

We recommend starting with the following information. Only include more if the payer requires it.

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| Information                               | Instructions                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              |   |                                   |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |   |                |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              |
| ----------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | - | --------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | - | -------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
| **Encounter**, service or procedure codes | You must include either a service type code (STC) or a procedure code and qualifier. This tells the payer what kinds of benefits information you're requesting. Most medical payers don't support procedure codes. Some dental payers do, but we recommend trying an STC first.<ul><li>We recommend STC `30` (Health Benefit Plan Coverage) to retrieve a patient's general medical benefits and `35` to retrieve a patient's general dental benefits. Visit [STCs and procedure codes](/providers/providers-stc-procedure-codes) for details about how to request benefits for specific medical and dental services.</li><li>We recommend including no more than one STC in each request.</li><li>By default, the real-time eligibility check form allows you to choose a **Service type code**. If you want to include a procedure code instead, click **Select fields** and select the boxes for the **Procedure code** and **Product or service ID qualifier** to add them to the form. Note that you can submit either an STC or a procedure code and qualifier - not both.</li><li>You can only submit STCs for batch checks in the `serviceTypeCode` field. Procedure codes aren't supported.</li></ul>                                                            |   |                                   |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |   |                |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              |
| **Encounter**, service dates              | Stedi uses the today's date in the payer's timezone as the date of service by default. If you want to check eligibility for today's date, don't submit a service date.<ul><li>To add past or future service dates to a real-time check, click **Select fields** and select either **Date of service** (single service date) or both the **Beginning date of service** and **End date of service** (date range).</li><li>To add past or future service dates in batch checks, use either the `encounterDateOfService` (single service date) or the `encounterBeginningDateOfService` and `encounterEndDateOfService` (date range) fields.</li><li> We recommend submitting dates up to 12 months in the past or up to the end of the current month. Payers aren't required to support dates outside these ranges. However, some payers such as the Centers for Medicare and Medicaid Services (CMS) do support requests for dates further in the future - especially the next calendar month. Check the payer's documentation to determine their specific behavior.</li></ul>                                                                                                                                                                                              |   | **Provider**, name and identifier | You must include the provider's name and an identifier. You can submit either the provider's organization name or their first and last name. For the identifier, we recommend submitting the provider's NPI. If they don't have an NPI, you can use an alternative, like their Social Security Number (SSN) or tax ID (EIN). <ul><li>By default, the real-time eligibility check form allows you to specify the provider's **Organization name**. If you want to include an individual provider's name instead, click **Select fields** and select **First name** and **Last name** under **Provider**.</li><li>By default, the real-time eligibility check form allows you to input the provider's **NPI**. If you want to use an alternative, click **Select fields** and select the **Tax ID** or **SSN** under **Provider**.</li></ul> |   | **Subscriber** | At a minimum, you must specify at least one of these fields in the request: **Date of birth**, **Last name**, or **Member ID**. <ul><li>Each payer has different requirements, so you should supply the fields necessary for each payer to identify the subscriber in their system.</li><li> When you supply the subscriber's member ID, first name, last name, and date of birth, payers are required to return a response if the member is in their database. Some payers may be able to search with less information, but this varies by payer.</li><li>Enter the subscriber's name exactly as written on their insurance card, if available, including any special or punctuation characters such as apostrophes, hyphens (dashes), or spaces.</li></ul> |
| **Subscriber**                            | <ul><li>At a minimum, you must supply at least the subscriber's **Member ID**, **Date of birth**, or **Last name**. However, each payer has different requirements, so you should supply the fields necessary for each payer to identify the subscriber in their system. </li><li>When you supply the subscriber's member ID, first name, last name, and date of birth, payers are required to return a response if the member is in their database. That's why these are the default form fields.</li><li>If you need to run an MBI lookup with the subscriber's Social Security Number (SSN), click **Select fields** and check the box next to **Social Security Number (SSN)** under the **Subscriber** section. This adds the SSN field to the form.</li></ul>                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |   |                                   |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            |   |                |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              |
| **Dependents**                            | A patient qualifies as a dependent for eligibility checks when they are listed as a dependent on the subscriber's insurance plan and the payer cannot uniquely identify the patient through information outside the subscriber's policy. If the patient has their own member ID (even if it only differs by a suffix like `0`), you must identify them in the **Subscriber** section instead. <ul><li>To add a dependent to the real-time eligibility check form, click **Select fields** and select **Dependents**.</li><li>You can only submit one dependent per eligibility check.</li><li> Most Medicaid plans don't support dependents - you'll almost always need to submit the child as a subscriber in the **Subscriber** section. Sending dependent information here for payers that don't support dependents will either cause an error, or the payer may return results for the subscriber instead.</li><li>We strongly recommend including the dependent's date of birth in the request when available because many payers return errors without it.</li><li>Enter the dependent's name exactly as written on their insurance card, if available, including any special or punctuation characters such as apostrophes, hyphens (dashes), or spaces.</li></ul> |   | **Trading partner service ID**    | You must specify the payer.<ul><li>For real-time eligibility checks, select the payer from the dropdown list.</li><li>For MBI lookups, you must select **CMS MBI Lookup** from the dropdown list.</li> <li>For batch checks, you must specify the payer's Stedi payer ID. You can find the Stedi payer ID in the [Payer Network](https://www.stedi.com/healthcare/network). You can use the Stedi payer ID or any Payer ID alias.</li></ul>                                                                                                                                                                                                                                                                                                                                                                                                |   |                |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              |

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