A verification failed, what do I do?

A check that did not pass looks alarming, but most of the time it is a small detail on the card, not a coverage problem. A member ID off by one digit, a birth year typed as this year, or a child entered where the parent belongs, and the carrier says "I don't recognize this person." The fix is usually one box and a re-check.

How you'll know a check did not pass

On the Verification tab:

• The patient shows in the red Verifications with a problem strip at the top, with a Fix now button.
• Their row in the list shows Needs fix. The Needs your fix chip lists every one.
• If the carrier found the patient but says the plan is inactive or has ended, the row shows Inactive and the button reads Add new card.
• If the carrier's own system did not answer, the row shows Re-check and says the carrier didn't answer. Nothing is wrong with the card: try again in a few minutes.

Read what the carrier said

Every card that did not pass says, in plain words, what the carrier answered and the one thing to do. For example: "Delta Dental of Virginia does not recognize the member ID you gave us," then "Check the member ID on the card, including any letters." Under that you see which carrier we sent it to and the carrier's code (for example code 72).

When it would help, the card also asks for details that let us search further: the patient's street address, ZIP code, or the policy holder's Social Security number.

Fix it and re-check

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.

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.

Patient on someone else's plan: for a child or spouse, the policy holder is usually a parent or partner, not the patient. Make sure the policy holder's name and date of birth belong to the policy holder, and set the relationship. If the carrier found the policy holder but not the patient, the panel asks which is true: the patient is on the holder's plan, or the patient has their own card.

Wrong carrier: a patient may have switched plans, or a medical plan was picked instead of the dental one. Aetna Dental and Aetna Medical, for example, are separate carriers, and "Delta Dental" is many separate state companies. Pick the exact carrier printed on the card from the list.

Plan ended or inactive: if the carrier says the plan has ended or is not active, the patient may have new insurance. Ask them for their current card and add it with Add new card on their row. The old card stays on the patient as history.

Carrier didn't answer: a timeout is a hiccup on the carrier's side, not a data problem. Wait a few minutes and run the check again.

Your practice is not set up with the carrier (codes 51 and 52): nothing on the card is wrong, so re-running cannot clear it. The panel shows the NPI we sent and three steps: check the NPI (usually the group NPI you bill under), make sure your CAQH profile is current, and ask the carrier for provider enrollment. See The carrier does not have your practice on file.

Frequently asked questions

The details look perfect but it still fails, now what? Look at the patient's card again, front and back, and compare every box. If the card matches and it still fails, press Fix now and use the right side of the pop-up: Send a fix request hands it to a person on our team, or call the carrier yourself (when we know their provider line, it is printed there). See After you send a fix request.

What does "code 33" mean? The carrier rejected the details but did not say which one. The panel shows every box the check sends, so you can compare the whole card in one place. Fix what is different and re-check.

What does "code 72" mean? The carrier does not recognize the member ID. Check it against the card character by character, including any letters, and make sure you picked the exact carrier printed on the card (dental, not medical).

A patient switched insurance, do I delete the old plan? No. When the carrier says the old plan ended, press Add new card on the patient's row and enter the new card; the old card stays on the patient as history. If the patient tells you about a new plan before any check shows it, open Plan basics › Edit on their row, enter the new card's details, and run the check. Every earlier check stays in the patient's Verification history.

Does a failed check cost me anything? On an insurance verification plan, you pay only for checks where the carrier found the patient. A check that finds no one is free when every required box was filled in: the patient's legal name and date of birth, the carrier, the member ID, and the policy holder's full Social Security number and home address (for a dependent, also the policy holder's name, date of birth and relationship). It is billed if one of those boxes was blank. A check the carrier never answered, or one refused because your practice is not enrolled with that carrier, is never billed. A plan that comes back inactive or ended is still a found check. See What a check costs.

Still stuck? Submit a ticket from Help (on Insurance Verification, pick A check didn't run correctly) with the patient's carrier and roughly when the check ran. A person on our team answers within one business day.