Two different statuses
Every verification has two statuses, and they answer different questions.
Verification status — did we get the information back?
Eligibility status — is the patient's plan active?
A verification can be Completed and still show the patient as Inactive. Completed means information came back. It does not mean the patient has coverage.
Verification statuses
Status | What it means | Refunded? |
Queued | We're working on it. Nothing for you to do. | Not applicable |
Completed | Information came back and is ready to view. Check the eligibility status to see whether the plan is active. | No — you got the result |
Action Required | Something in the patient or provider information needs to be corrected by your office. Open the item to see the reason. | No |
Failed | We couldn't get the information, and it isn't your data. Nothing for you to fix. | Yes |
Unavailable | No clear eligibility answer came back, or that insurance company doesn't support instant basic eligibility checks. | Yes |
Cancelled | The verification was stopped before it finished. | Yes |
No PDF is produced for Action Required, Failed, or Unavailable.
Eligibility statuses
Status | What it means |
Active | The plan is in force. Good to schedule and treat. |
Inactive | The plan isn't currently in force. Ask the patient for current coverage. |
Not Covered | The insurance company says this patient isn't covered under this plan. Confirm the plan and subscriber with the patient. |
Terminated | Coverage ended. Ask the patient whether they have a new plan. |
Expired | The information we have is too old to rely on. Re-run the verification before the appointment. |
Unknown | Nothing conclusive came back either way. Re-run it, or call the carrier if the appointment is close. |
Half circle and full circle
The small circle on the status badge tells you which kind of verification was run.
Half circle — a basic verification. Eligibility and top-level coverage only.
Full circle — a full breakdown. The complete detail, including categories, percentages, frequencies, and history.
Empty circle — no verification has been run for this patient yet.
We recommend a full breakdown for every new patient.
More about Action Required
Action Required always means the ball is in your court. It's never used for a problem on our side. Open the item to see the exact reason, fix the information, and it runs again.
For the full list of causes and fixes, see Why is my verification showing Action Required?
More about Failed
Failed means we tried and couldn't get an answer, for reasons you can't fix. Common causes:
The insurance company refused to speak to a third-party caller.
No live representative could be reached after repeated attempts.
The carrier only handles provider inquiries by email.
The carrier requires portal access we don't have for your office.
A temporary problem on the insurance company's end.
Failed verifications are refunded. If a particular carrier fails repeatedly for you, contact us — some of these can be resolved by setting up access on your account.
More about Unavailable
Unavailable means no conclusive eligibility answer came back, or the insurance company doesn't support instant basic eligibility checks at all. It is much more common than Failed, and it's also refunded.
If you need coverage details for that patient anyway, run a full breakdown instead of a basic check.