A verification failed — what do I do?

A red Verification failed — see why badge looks alarming, but nine times out of ten it's a small data problem, not a coverage problem. A member ID off by one digit, a birth year typed as this year, or a child listed where the parent should be — any of these makes the payer say "I don't recognize this person." The fix is usually one field and a quick re-run.

How you'll know a check failed

The patient's coverage header shows one of these instead of the green Verified pill:

• Verification failed — see why — the payer rejected the request outright.
• Coverage terminated — see why — the payer says the plan is no longer active.
• Coverage inactive — see why — the member exists, but the plan isn't currently in effect.
• Partial response — see why — the payer confirmed eligibility but didn't send the full benefit detail.
• Verification expired (amber) — not a failure, just an old check that's due for a re-run.

Amy also drops a task into What needs to get done for anything that needs a human, so a failed check won't quietly slip past your team.

Open the "see why" explainer

Click the red badge and Amy translates the payer's terse code into plain English. The explainer is laid out in four parts:

• What it means — the failure in one sentence.
• Likely the problem — the specific fields worth checking first.
• What to do — the exact steps to fix it.
• Raw carrier response — the original payer message, tucked in an expander, if you want the underlying detail.

From there, press Go to Plan basics to fix and the page scrolls straight to the fields you need to edit.

Fix it and re-run

The most common causes, and the fix

Member ID typo — the single most common cause. Compare it to the card character-by-character; watch for a missing letter prefix or an off-by-one digit.

Subscriber name mismatch — the name must match the card exactly. No nicknames, no added middle initial. "Bob" won't match "Robert."

Wrong birth year — the classic slip is typing the current year instead of the patient's birth year. Confirm the year.

Dependent listed as subscriber — for a child or spouse, the subscriber is the policy holder (usually a parent or partner), not the patient. Make sure the subscriber name and DOB belong to the policy holder and set the relationship correctly.

Wrong carrier — a patient may have switched plans, or the medical arm was picked instead of the dental one. Aetna Dental and Aetna Medical, for example, are separate payers. Confirm the carrier and payer ID.

Coverage terminated or inactive — if the payer insists the plan is ended or not yet active, the patient may have changed insurance or started a new policy. Ask them to confirm the carrier and, if it changed, to text a photo of the new card using Contact patient for new card.

Carrier didn't respond in time — a timeout is usually a temporary hiccup on the payer's side, not a data problem. Wait a couple of minutes and press Re-verify.

Frequently asked questions

The details look perfect but it still fails — now what? Request a fresh photo of the patient's card and compare every field again. If the card matches and it still fails, the payer's system may be down; try again shortly, or call the number on the back of the card.

What does "Code 33: Input Errors" mean? It's the payer saying the identifying details don't match anyone in their system — almost always a typo in the member ID, name, or date of birth. Fix the flagged field and re-verify.

What does "Code 72" mean? The member ID and date of birth combination doesn't exist at that payer. Re-check the member ID character-by-character, confirm the subscriber is the policy holder, and make sure you picked the right carrier (dental vs. medical).

A patient switched insurance — do I delete the old plan? No need to delete it. Add the new plan and set it as primary; the old plan stays in the history. Ask the patient to send the new card so Amy can verify it.

Does a failed check cost me anything? Only successful, completed verifications draw down your usage in the normal way. Re-runs are quick and expected — fix the field and re-verify with confidence. For how usage is counted, see How the $1,000 credit works.

Still stuck? Submit a ticket from the Help Center or email help@valiansystems.com with the patient's carrier and roughly when the check failed, and we'll dig in with you.