Automatic Eligibility Checks let Solum verify a patient’s coverage the moment they enter an Insurance Verification workflow stage — no manual steps required. For every payor on the patient that is ready to be checked, Solum runs a real-time eligibility check and, when the result comes back Active, fills the payor’s benefits automatically.
This feature is opt-in per company and runs alongside the normal verification flow: the manual verification task your team already relies on is still created every time. Automatic checks save your team the first pass — they never remove the human safety net.
Enabling the Feature
- Go to Settings → Company.
- Find the Automatic Eligibility Checks section.
- Turn on Run eligibility checks automatically.
- Pick the Default service type (up to 2). This is the fallback used only when neither the payor’s own services nor the patient’s referral specify any service types. The default is Health Benefit Plan Coverage, which returns general plan benefits. See Service Type Codes for the full list.
Only company administrators can change these settings. The service types you select here are a fallback — each payor resolves its own service types first, and this default only applies when nothing more specific is found (see How service types are chosen). Checks triggered manually from the Eligibility Checks page are not affected by this setting.
What You Need Before It Works
An automatic check only runs when Solum has everything it needs to submit a valid eligibility request. Use this checklist when setting up:
Company setup
| Requirement | Where to configure |
|---|
| Automatic Eligibility Checks enabled | Settings → Company |
| Exactly one credentialing record of type Entity — or exactly one Entity NPI whose location state matches the patient’s state | Credentialing |
| A workflow stage with Stage Type = Insurance Verification | Workflow Stages |
NPI selection is deliberately conservative. If your company has multiple Entity NPIs and none (or more than one) matches the patient’s state, Solum cannot decide which NPI to use and skips the automatic check rather than guessing. The manual verification task is still created, so nothing is lost — the check just isn’t automated for that patient.
Patient setup
| Requirement | Notes |
|---|
| First name, last name, and date of birth | Required to identify the subscriber with the payer |
| State | Only needed when your company has more than one Entity NPI (used to pick the right one) |
Payor setup
Each of the patient’s payors is checked independently. A payor qualifies when:
| Requirement | Notes |
|---|
| Payor is active | Inactive payors are ignored |
| Responsibility is set | Each payor must be marked Primary, Secondary, or Tertiary. Payors with no responsibility are skipped |
| Member ID is filled in | Without it the payer cannot find the subscriber. Spaces and punctuation are cleaned automatically; a Member ID with no letters or digits is treated as missing and that payor is skipped |
| The payor’s insurance has an Eligibility Payer selected | This is the link to the eligibility network — see Insurances |
How service types are chosen
Automatic checks no longer use a single company-wide service type for every payor. Instead, each payor resolves its own service types from the first source below that has any — the same order the manual new-check form uses:
- The payor’s own services — the services configured directly on that payor.
- The patient’s most recent referral that lists service types.
- Your company default — the Default service type from Settings → Company.
- If none of the above yields anything, Solum falls back to Health Benefit Plan Coverage.
Whichever source matches first is used; the others are not combined. Each check is still capped at 2 service type codes (duplicates are removed first, so a repeated service can’t crowd out a second distinct one).
How a Run Works
- A patient is moved into a workflow stage with Stage Type = Insurance Verification.
- Solum waits about 20 seconds. If the patient is moved to a different stage during that window, the automatic check is cancelled — this protects against accidental drag-and-drop moves.
- The usual manual verification task is created (this always happens, with or without automatic checks).
- For each qualifying payor, Solum runs a real-time eligibility check using the patient’s details, the payor’s Member ID, your Entity NPI, and the service types resolved for that payor (see How service types are chosen). The date of service is the current date.
- Every result is saved to the Eligibility Checks page, linked to the patient — exactly as if someone had run it manually.
- If a result comes back Active, Solum automatically matches it onto the payor: benefits (copay, coinsurance, deductible, out-of-pocket) are filled in from the check.
Safeguards and Limitations
These rules are intentional — they keep automatic checks from wasting payer calls or overwriting your team’s work:
| Behavior | Detail |
|---|
| Recently checked payors are skipped | If a payor was verified within the last 7 days, no new automatic check runs for it. This prevents duplicate checks when a patient re-enters the verification stage. |
| Human work is never overwritten | If someone has already started or completed verification work on a payor, the automatic check is still saved to the Eligibility Checks page, but its result is not matched onto the payor. |
| Only Active results are matched | Inactive, error, or undetermined results are saved for review but never change the payor’s benefits. |
| Ambiguous NPI → no automatic check | See the warning above. The manual task still covers the patient. |
| Payors without a responsibility are skipped | A payor must be marked Primary, Secondary, or Tertiary. Payors with no responsibility set are skipped (the manual task still covers them). |
| Invalid Member IDs are skipped | A Member ID with no letters or digits is treated as missing, so that payor is skipped. Other payors on the patient are still checked. |
| One payor failing doesn’t stop the others | If a check fails for one payor (for example, a payer connection error), the remaining payors are still checked. |
| Fixed date of service | Automatic checks always use today’s date. For a different date of service, run a manual check from the Eligibility Checks page. |
Even with automatic checks enabled, the manual eligibility check flow stays fully available — use it for service types or dates of service that differ from what the automatic check resolves.
Verifying It’s Working
Use this script to confirm the feature end to end:
- Set up — confirm every item in What You Need Before It Works: feature enabled, one Entity NPI, a test patient with name + date of birth, and a payor with a Responsibility and a Member ID, on an insurance that has an Eligibility Payer.
- Trigger — move the patient into your Insurance Verification stage (drag the patient card, or change the stage from the patient’s profile).
- Wait ~30 seconds — the check runs about 20 seconds after the stage change.
- Check the results:
- The Eligibility Checks page shows a new check for the patient.
- If the result is Active, open the patient and confirm the payor’s benefits were filled in.
- The manual verification task was also created — automatic checks never replace it.
- Test the recheck guard — move the patient out of the stage and back in: no second check should appear (the payor was verified less than 7 days ago).
Troubleshooting
| Symptom | Likely cause | Fix |
|---|
| No check appears after the stage change | Feature is off | Enable it in Settings → Company |
| No check appears | Payor was verified in the last 7 days | Expected — wait for the window to pass, or run a manual check |
| No check appears | Payor has no Member ID | Add the Member ID to the payor and re-enter the stage |
| No check appears | Member ID has no letters or digits (only spaces/punctuation) | Correct the Member ID on the payor and re-enter the stage |
| No check appears | Payor has no Responsibility set | Set the payor’s Responsibility (Primary / Secondary / Tertiary) |
| No check appears | The payor’s insurance has no Eligibility Payer | Edit the insurance and link an Eligibility Payer (Insurances) |
| No check appears | Zero or multiple Entity NPIs, none uniquely matching the patient’s state | Consolidate to one Entity NPI, or make sure exactly one matches the patient’s state (Credentialing) |
| No check appears | Patient was moved out of the stage within ~20 seconds | Move the patient back into the stage |
| Check appears but benefits weren’t filled in | Result was not Active | Expected — review the check on the Eligibility Checks page |
| Check appears but benefits weren’t filled in | Verification work already in progress on the payor | Expected — automatic matching never overwrites your team’s work |
| A check ran but used the wrong service type | Service types come from the payor’s services, then the patient’s referral, then your company default | Set the payor’s services (or your company default) to control this — see How service types are chosen — or run a manual check for one-off needs |
