Overview 

Every January, many providers typically run thousands of additional eligibility checks and prior authorizations to update patient records for the new year. This increased activity across the healthcare industry can create higher-than-normal traffic on payer systems, which may impact transaction processing.

This article outlines potential issues you may encounter and simple steps to resolve them. Most of these are normal seasonal patterns and can be resolved without support intervention.

Benefits Verification (Eligibility)

Payer System Delays

You may see:

• Slower response times or timeout errors
• "Payer Unavailable" or "Unknown Payer" messages

What's happening: Payers may experience high traffic on their 270/271 networks, particularly during the first week or two of January and early in the week.

If this happens: Simply retry the transaction later in the day or the next business day. These delays are temporary and reflect payer system capacity, not issues with our platform. No support ticket is typically required for these and should be resolved shortly.

Patient Information Updates

You may see:

• Invalid Patient ID, Subscriber ID, or demographic information errors
• Unexpected changes to plan coverage or benefits
• Different Coordination of Benefits (COB) results
• Changes to your network status with certain payers

What's happening: Many patients' health plans change at the start of the year. Even if they stay with the same employer and payer; their subscriber ID, group number, plan selection, or coverage order may have changed. Plan designs and provider networks are also commonly renegotiated annually.

If this happens:

• Contact the patient to verify their current insurance card information
• Update subscriber ID, group number, and demographics in your system
• Check that primary/secondary insurance order is correct for patients with multiple coverages
• If network status seems incorrect, verify directly with the payer

This is normal annual activity and typically doesn't require a support ticket.

Benefit Resets

You may see: Deductibles, out-of-pocket maximums, and accumulators showing $0 applied.

What's happening: Most health plans reset these amounts on January 1st.

If this happens: No action needed, this is expected behavior. Just be prepared for patient financial conversations about their new benefit period.

Prior Authorization

You may see:

• Services requiring PA that didn't require it in 2025 (or vice versa)
• Longer wait times for PA determinations
• More frequent requests for additional clinical documentation

What's happening: Payers regularly update their PA policies at the start of each year and may experience higher submission volumes during January. Some payers also conduct more clinical reviews during this period.

If this happens:

• Review PA requirements for all services, even if they were previously unrestricted
• Submit PA requests earlier than usual to account for potential delays
• Include comprehensive clinical documentation with initial submissions
• Allow 2-3 extra business days for determinations during early January

Most PA delays resolve within the first few weeks of January as payer traffic normalizes.

What to Remember

✅ These issues may occur during the first 2-3 weeks of January but are temporary

✅ Many issues are related to payer system traffic or annual plan changes—not platform problems

✅ Simple steps like retrying transactions or verifying patient information often resolve issues quickly

✅ When to contact support: If you encounter persistent errors that don't match these patterns or last beyond 48 hours, we're here to help