The short answer
Action Required means something in the patient or provider information needs to be fixed by your office. The insurance company was reached, but it rejected one of the details we sent — usually a member ID, a date of birth, a name, or the provider's credentials.
Action Required is never used for a problem on our end. If we can't get the information for reasons outside your control, the verification comes back as Failed or Unavailable instead, and those are refunded automatically. Action Required is not refunded, because the work was done and the next step belongs to your office.
Where to see the reason
Go to Insurance Verification → Action Items and click the item. Near the top you'll see a red What's Incorrect card with the specific note about what went wrong.
The status badge in list views only says "Action Required." It never shows the reason. You have to open the item to see it — this is the step people miss most often.
How to fix it
What you do next depends on whether your account is connected to your practice management system.
Connected to a practice management system: the fields are not editable in Stratus. Correct the information in your practice management system. The next sync picks up the change — normally a few minutes during the business day — and the verification resubmits on its own.
Not connected: open the item and click Edit & Resubmit. Correct the fields, save, and the verification runs again.
If you don't want to retry it at all, use Archive to take it off the list.
The most common causes
Member or subscriber ID is wrong or missing. This is the number one cause by a wide margin.
What to do: re-key the ID exactly as it's printed on the patient's current card, including any letters or leading zeros.The insurance company can't find the patient. The details look fine, but nothing matches on their side.
What to do: confirm the carrier, the state, and the plan name. Ask the patient for a photo of both sides of the card.Date of birth doesn't match. Off by a digit, or the subscriber's date of birth was entered for the patient.
What to do: confirm the date of birth with the patient and check both the patient and the subscriber.Provider NPI or Tax ID isn't recognized. The insurance company doesn't have those credentials on file.
What to do: the provider has to contact the insurance company directly to get their records updated. We cannot fix this for you, and resubmitting won't help until the carrier updates their records.Patient name doesn't match. A nickname, a maiden name, or a hyphenated last name entered differently than the policy has it.
What to do: use the legal name exactly as it appears on the policy.Portal access or authorization is missing. Some carriers won't release information to us without a signed third-party authorization from your office.
What to do: ask the carrier for their third-party authorization form, sign it, and submit it to them.Coverage is inactive or terminated. The plan on file has ended.
What to do: ask the patient for their current coverage and update the record.Group number is missing or wrong.
What to do: copy the group number from the card. Some plans won't return anything without it.The date of birth entered isn't a real date — a date in the future, or an age over 120. You'll see a note like: "Patient date of birth is invalid (01/01/2035). Please correct it and confirm the date of birth is updated in Stratus before submitting a new breakdown."
What to do: fix the date, then make sure the corrected date shows in Stratus before you submit a new breakdown.
Less common causes
The carrier needs an organization or office code in addition to the NPI.
The provider isn't contracted with that carrier.
The patient hasn't signed a HIPAA release.
The plan is medical-only and has no dental coverage.
The carrier wants the patient's address, phone number, or Social Security number before releasing anything.
The provider's office address doesn't match the carrier's records.
The wrong subscriber is attached to the patient record.
The carrier's phone number on file is disconnected.
How to avoid these
Enter the complete member ID, exactly as printed.
Enter correct dates of birth for both the patient and the subscriber.
Use legal names, not nicknames.
Keep a current copy of the insurance card on file.
Keep each provider's NPI and Tax ID correct in your practice record.
Wondering what the other statuses mean? See Verification statuses explained.