Verification

Verifications are a core concept of the Sohar platform. A Verification represents a request for eligibility status and benefits information for a given patient.

Providers

A National Provider Identifier (NPI) is a unique 10-digit number assigned to healthcare providers in the U.S. There are two types of NPIs relevant here: Type 1 (rendering provider), which identifies the individual delivering care (e.g., a doctor), and Type 2 (group provider), which identifies the organization or practice (e.g., a clinic). Some payers require an NPI for a credentialed provider in order to return patient data. Depending on the payer, this may be a Type 1 or Type 2 NPI. If a required NPI is missing, the request will fail with an error.payer.npi response. Sohar handles this complexity automatically using the providers enrolled in your account. To avoid provider-related errors, make sure your providers are enrolled - either through the dashboard or programmatically using the Create Provider API.

Statuses

Status	Description
complete.eligible	The verification was successfully completed; patient is confirmed active coverage and covered for the provided taxonomy code.
complete.ineligible	The verification was successfully completed; Patient is either inactive and/or not covered for the provided taxonomy code.
error.member.id	The member ID was not recognized by the payer, or a different payer ID should be used.
error.member.dob	The patient’s Date of Birth was not recognized by the payer, or a different payer ID should be used.
error.member.name	The patient’s name was not recognized by the payer, or a different payer ID should be used. This is often due to incorrect spelling or nicknames.
error.payer	The payer has been unavailable for over 24 hours and the Sohar Operations team has been unable to resolve the verification via payer portal or phone call. This status may also occur when the verification requires manual contact with the payer but manual resolution is not enabled for your account.
error.payer.npi	The provided NPI is not recognized by the payer. Some payers require an NPI on file in order to provide benefits. Some payers require a rendering NPI in order to provide benefits, for example Blue Cross Blue Shield of Texas.
pending	The verification could not be resolved immediately, typically because the payer API was unavailable. A verification with this status will be followed by one of the statuses listed above.

Sandbox Values

Use the following payerId and memberId values in the sandbox environment for predefined responses.

Payer ID	Member ID	Status
60054	00000000	complete.eligible
60054	00000001	complete.ineligible
60054	10000000	error.member.id
60054	10000001	error.member.dob
60054	10000002	error.member.name
OSCAR	00000000	error.payer.npi
06111	00000000	pending

Getting Started

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Providers

Statuses

Sandbox Values

​Providers

​Statuses

​Sandbox Values

Providers

Statuses

Sandbox Values