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Automatic Eligibility Checks

Eligibility is the first step of every verification of benefits (VOB). As soon as a VOB is created, Solum runs one real-time eligibility check per requested specialty — using that specialty’s place of service, and its CPT codes for payers that answer per procedure — and writes the answer onto the VOB. When a check that asked about CPT codes doesn’t come back active, Solum asks again without them, so the patient’s status never depends on them. This runs on every VOB automatically; there is no setting to turn it on or off.
Asking about CPT codes only when the payer answers per procedure is coming with the next release. Until then, every check asks the payer about the specialty’s CPT codes.

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When it runs

A VOB is created, and its checks queued, in a few ways:
  • Your intake integration sends Solum a patient — the connection Solum set up with your CRM or intake system. Solum opens one VOB per active policy that doesn’t already have an open one, requesting the disciplines described in How service types are selected unless the intake names them. A coverage the intake names that already has an open VOB fails the request instead.
  • You request a VOB directly — from the patient’s profile, or through the API — naming the specialty or specialties you want verified.
In every case, the eligibility check starts within moments of the VOB being created, before anyone opens it.

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What happens to the result

  • When the payer confirms Active or Inactive coverage, Solum writes the result onto the VOB right away. You don’t attach anything yourself — open the VOB and the result is there.
  • Any other outcome — the payer doesn’t recognize the member (a missing or mismatched date of birth, member ID, or subscriber name), the insurance has no eligibility payer configured, or the payer or clearinghouse itself is unavailable — reports nothing on the VOB. Nothing is lost: the check still appears on the Eligibility Checks page, and the Solum team follows up or retries it, asking you for corrected details only if it needs them.
Only Solum applies a check’s answer to a VOB, and only while the VOB is still open — a completed VOB’s result is frozen. You can see and retry checks on the Eligibility Checks page, but attaching one to a VOB is Solum’s job. If you think a check should be reflected on a VOB and it isn’t, reach out to your Solum team.

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How service types are selected

When you request a VOB yourself, you choose the specialty (or specialties); the credential, CPT codes, and place of service default from your company’s setup unless you specify otherwise. When Solum creates the VOB for you — from your intake integration, without naming specialties — it derives which specialties to request from the first source below that has anything configured, in this order:
  1. A per-state override, if your company has one configured for the patient’s state.
  2. Your company’s default service types, under Settings → Eligibility.
  3. The policy’s last verified services — the disciplines from its most recent result.
  4. The patient’s active referrals — every distinct discipline across them.
Every discipline in the winning source is requested; Solum doesn’t hold any of them back. If none of these produce anything, no VOB is created for that policy, and the patient gets a note explaining what’s missing.
A payer rule can also require one plan-level check (“Health Benefit Plan Coverage”) that answers on behalf of every requested discipline. This changes how Solum asks the payer, never which disciplines were requested.

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Provider NPI

Solum resolves a provider NPI separately for each specialty, once, when the specialty is added to the VOB:
  1. If the specialty’s credential is pinned to an insurance with Use this NPI for automatic checks, that NPI is used.
  2. Otherwise, Solum looks at your active Entity credentialing records. It uses a unique state match, one NPI repeated across multiple locations, or the configured default Entity NPI — in that order.
  3. If several genuinely different NPIs remain ambiguous and there is no per-insurance or default selection, that specialty is skipped — no check runs for it, though the rest of the VOB still does.
For state matching, the patient’s state is used first. If it is blank, the state of the patient’s assigned location is used.

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Member ID

Member IDs are normalized before every check: spaces and punctuation are removed, and payer-specific normalization is applied where required. If no letters or digits remain after normalization, that specialty is skipped. Patient name and date of birth are included in the eligibility request when available.

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Safeguards and limitations

The manual eligibility check flow remains available for a different date of service or a one-off combination of service types, independent of any VOB.

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Verify the setup

  1. Confirm the patient has an active policy with a responsibility tier, Member ID, and an insurance linked to an Eligibility Payer.
  2. Confirm the policy can resolve both a provider NPI and at least one service type using the rules above.
  3. Request a VOB for the policy from the patient’s profile.
  4. Open the patient’s VOB and confirm the result appears there. If it doesn’t within a few minutes, check Eligibility Checks for what the payer returned, or reach out to your Solum team.

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Troubleshooting