Why am I still receiving an error on my eligibility request after my NPI submission has been completed?

Last Updated November 26th, 2018

For eligibility transactions, there can be two different ‘layers’ of NPI requirements. The first requires that you register the NPI you’ll be using in eligibility submissions prior to transacting with with a trading partner. This registration allows PokitDok to submit the eligibility request on behalf of the provider and can be completed via the PokitDok platform.

This requirement is indicated in the ‘Provider registration’ column on our trading partners page, and most trading partners do not have this requirement for eligibility transactions.

A second layer of registration requirements is when a trading partner requires that a provider be in-network with them prior to submitting transactions. Because these requirements can change and are completely at the discretion of the trading partner, PokitDok is unable to document these. If a provider is considered out-of-network, the trading partner will include one of the following rejections in the eligibility response. The next step will be for the provider to work with the payer directly to become in-network with them.

The following errors are a good indication that the NPI included in the request is not in-network (credentialed) with a trading partner.

invalid_provider_id
provider_not_on_file
provider_ineligible_for_inquiries

A full list of reject_reasons is available in our documentation

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