Payer Icons, Common Errors and Eligibility Troubleshooting

When viewing patient information for either a visit or an appointment, there will be a few types of colorful icons displayed showing the status of the insurance for the individual patients. Below is a list of those icons and what each means.

List of Icons (and their meanings):

Icon	Meaning	Action
	Active Coverage	Verify there are no additional flags; review and update patient information based on any flags.
	Invalid Data / Data Entry Error	Compare the data in Clearwave to that on the patient’s insurance card. Correct any errors and resubmit the information. If the error message says “Could not respond at current time”, try resubmitting eligibility later. Review and update the patient information based on any flags. Update the patient’s eligibility information in the PMS/HIS.
	Inactive	Verify it is the patient’s most recent insurance card. Compare the data in Clearwave to that on the patient’s insurance card. Correct any errors or update with new insurance information, and resubmit the information. Review and update the patient information based on any flags. Update the patient’s eligibility information in the PMS/HIS.
	Resubmit	This could be the result of a timeout or a loss of connection to the payer and can be solved by resubmitting the insurance.
	Unlisted Payer	*Clearwave does not process eligibility for that payer. Double check the name of the insurance company selected. Compare the data in Clearwave to that on the patient’s insurance card. Correct any errors and resubmit the information with a listed payer in Clearwave. Review and update the patient information based on any flags. Update the patient’s eligibility information in the PMS/HIS.
	Self Pay	No action required.

Common Errors and Troubleshooting Options for icon:

Most of these errors are from information being transferred incorrectly from the scanned driver's license and insurance cards to the correlating fields. If the driver's license or insurance card has a different member name or member ID, the solution is to go through the process to resubmit the insurance and change the incorrect data to the correct one on the card or ID.

If the patient goes by a nickname but their insurance card has their full name, the insurance will come back with an error message that can be resolved by changing the patient's name and resubmit the insurance.

If the patient is a child or spouse to the insured who's information is on the card, then an error message might appear that can be resolved by changing the drop down menu that says "relationship to subscriber."

If the error message says, "invalid login/contact administrator," this means the password for the direct connection associated with that insurance needs to be updated. See "How to change direct connection password" for instructions on how to update the password.

Below is a table of common errors and troubleshooting options:

Authorization/Access Restrictions	TaxID/NPI setup in Clearwave is not the TaxID/NPI the payer has on file. Notify Clearwave Support of the correct TaxID/NPI for the payer.
Contact Following Entity for Eligibility or Benefit Information	Response will display with an active icon; however, the additional plan must be verified. Eligibility is actually held with another payer, not the payer the patient was initially submitted through. Resubmit through the additional payer to verify coverage.
Invalid login/contact administrator	Credentials used for enhanced connection is invalid and needs to be updated. See "How to change direct connection password" for instructions on how to update the password.
Invalid response from payer	Response from payer is an unrecognized format.
Invalid/Missing Patient Gender Code	Correct patient gender and resubmit.
Invalid/Missing Patient ID	Correct patient member ID and resubmit.
Invalid/Missing Patient Name	Correct patient name and resubmit.
Invalid/Missing Subscriber/Insured ID	Correct patient member ID and resubmit.
Invalid/Missing Subscriber/Insured Name	Correct patient name and resubmit. Note: If the patient goes by a nickname but their insurance card has their full name, the insurance will come back with an error message that can be resolved by changing the patient's name and resubmit the insurance.
Patient Birth Date Does Not Match That for the Patient on the Database	Correct patient DOB and resubmit.
Patient Not Found	Based on insurance information submitted, patient was not found in payer’s database. Update patient’s information and resubmit.
Subscriber Found, Patient Not Found	Subscriber plan exists, but patient not listed under plan. Most likely will happen in parent/child scenarios.
Subscriber/Insured Not Found	Correct patient information and resubmit.
Subscriber/Insured Not in Group/Plan Identified	Plan exists under submitted member ID; however, patient not found under plan. Try correcting information and resubmit.

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