Eligibility Mapping Troubleshooting

Overview

Before you begin

• Confirm you can access the client’s workspace in Calvient.
• Confirm the client can see Payers under Config.
• Have the payer name as it appears in the electronic health record (EHR) ready.
• Have the client’s organization National Provider Identifier (NPI) and tax ID ready if the payer may require enrollment.
• Be ready to check the Stedi Payer Network for alternate payer names.

Steps

1. Open the client workspace in Calvient.
2. Click Config.
3. Click Eligibility 
4. Click Payers.
5. Review the Your Payers tab. You’ll see the client’s payer rows and their current mapping status.
6. Review the Enrollment Status column to find rows that need work.
7. Click Auto-Map Payers if you want Calvient to try matching unmapped payers first.
8. Wait a few minutes for the auto-mapping job to run.
9. Refresh the page.
10. Review any rows that still show Not Mapped or an incorrect Calvient Payer Name.
11. Click Edit on the row you want to fix.
12. Review the current mapping message if it appears. It tells you which payer is mapped now.
13. Enter the payer name in Search Payers.
14. Review the search results.
15. Look for the best payer match by name and ID.
16. Look for the Eligibility badge if you need a payer that supports eligibility checks.
17. Click Select next to the correct payer.
18. Click Save.
19. Confirm the remap if Calvient warns that the change will reset eligibility enrollment status.
20. Review the row again after the save completes.
21. Treat Ready or Enrolled as successful outcomes.
22. Treat Not Mapped, Not Supported, Enrollment Required, Pending, or Unknown as signs that more work is needed.
23. Click All Payers if you want to research payer records already loaded into Calvient.
24. Enter a term in Search for a record to narrow the list.
25. Click a payer row to open its details.
26. Review Stedi ID, phone, address, and Eligibility Status.
27. Open the Stedi Payer Network if Calvient does not return a clear match.
28. Enter the payer name in Name & ID.
29. Review the payer card for alternate names and the primary payer ID.
30. Review Transactions to confirm the payer supports eligibility checks.
31. Review Coverage Type and Operating States if the payer has multiple similar records.
32. Return to Calvient.
33. Enter the alternate payer name you found in Stedi in Search Payers.
34. Click Select for the best match.
35. Click Save.
36. Click Remove Mapping if the current mapping is wrong and you need to clear it completely.
37. Review the payer row again after the next sync if the enrollment status does not update right away.

Troubleshooting

• If Payers does not appear under Config, then confirm the client has the auto-eligibility feature enabled.
• If Search Payers returns no results, then search the payer in the Stedi Payer Network and retry with an alternate payer name.
• If Stedi shows several similar payer records, then use Transactions, Coverage Type, and Operating States to narrow the match.
• If the payer row shows Not Supported, then the payer does not support electronic eligibility through the clearinghouse.
• If the payer row shows Enrollment Required, then the payer supports eligibility but the client must complete clearinghouse enrollment before checks can run.
• If the payer row shows Pending, then the enrollment is still in progress and eligibility checks cannot run yet.
• If the payer row shows Unknown after a new mapping or remapping, then wait for the clearinghouse sync to update the status.
• If a working status disappears after a remap, then treat that as expected because Calvient resets enrollment status when the mapped payer changes.
• If Auto-Map Payers does not map a payer, then map it manually. Auto-mapping skips low-confidence matches.
• If the same payer appears more than once in Your Payers, then compare the payer rows before mapping. Client payer records can exist as separate rows.
• If a payer row is missing from Your Payers, then confirm the client’s payer list has been synced from the EHR. 
• If the payer should be enrolled but never moves out of Unknown, Enrollment Required, or Pending, then verify the client’s organization NPI and tax ID match the clearinghouse enrollment record.
• If the primary payer ID starts with 0, then keep the leading zeroes when you compare records in Stedi.
• If the payer is mapped correctly but eligibility still fails, then verify payer-specific enrollment requirements and any payer-specific credentials or access rules.
• If you need to submit or review clearinghouse enrollment, then contact Calvient or the representative who manages your payer enrollment and credentials.