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. |
| 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 | error.payer.npi | |
| 06111 | pending |