EDD approved then denied claim same day - facility licensing issue causing payment delays

This happened to my brother last year - sounds like a database error on EDD's end. The facility licensing issue is actually pretty common with mental health facilities because EDD has outdated information. Since you got the approval letter with a benefit amount, that's actually a good sign! The most important thing is to get this fixed ASAP and here's what worked for us: 1) Have the facility fax (yes, fax!) a copy of their current license directly to EDD with your husband's claim number clearly marked 2) Submit an appeal through SDI Online (if you can get in) or by mail using the DE 1000A form - specifically note the contradictory letters 3) Explain in the appeal that the facility IS licensed and other patients receive benefits The online account issue might be a separate problem - sometimes they lock accounts when there are conflicting claim statuses.

cant u just call them??? thats wat i did when my claim got all messed up

I'm a peer counselor at a mental health facility and we see this ALL THE TIME with EDD. The licensing verification system they use is terribly outdated. Your husband's claim is caught in what we call a "split decision" where the automated system approved it based on his medical certification, but then the licensing verification flag triggered a denial. Here's what you need to know: 1) This is 100% fixable but will take some persistence 2) The approval letter actually holds more weight legally 3) You need to get past the frontline reps and speak to a claim specialist who can override the licensing flag The account access issue is related - when claims have contradictory statuses, the system sometimes restricts online access as a security measure. It's frustrating but actually means the system is doing what it's supposed to (preventing changes while there's a decision conflict).

Have you tried using Claimyr to reach EDD? After struggling for weeks to get through on my disability claim, I found their service and was talking to an EDD agent in like 20 minutes. You can see how it works in this video: https://youtu.be/1X-mEsLtbmQ?si=1hcSq3KFtCr4oAmd Their website is claimyr.com - it basically calls EDD for you and gets you past the busy signals so you can talk to an actual agent. For a situation like yours with conflicting approval/denial, you definitely need to speak with someone directly who can see both decisions in the system.

@skeptical - I felt the same way at first, but after spending 3 weeks trying to call EDD myself, it was worth it to finally get through. The service just helps you bypass the phone system - once connected, you're talking directly to actual EDD agents. I was able to fix my pending payment issue in one call.

The issue is 100% with EDD's outdated facility database. My wife works at EDD (not in claims but in IT) and she says they're still using a database from 2017 for certain facility verifications! The approval letter is actually correct and the denial is an automated error. I recommend: 1. File a formal appeal immediately using the DE 1000A form you can download from EDD's website 2. Have the facility provide a letter with their license number, effective date, and current address 3. Include with your appeal a copy of BOTH letters showing the contradictory decisions 4. Note in your appeal that other patients at the same facility receive benefits The good news is these licensing denials are usually overturned within 10-14 days once properly appealed. The bad news is you'll still need to wait for processing.

Definitely try calling while also pursuing the appeal. The appeal is your formal recourse, but a knowledgeable claims specialist can sometimes override the licensing flag immediately if you can reach one. Just make sure to have all the facility license information ready when you call.

One more important tip - make sure the facility includes their official NPI (National Provider Identifier) number on any documentation they provide. EDD uses this as a secondary verification method, and it can sometimes bypass their outdated facility database altogether.

UPDATE: I finally got through to EDD using Claimyr! The agent was able to see both the approval and denial in the system. She said it was definitely a licensing database error and has submitted an override request to fix it. She said the payments should be released within 5-7 business days! Thank you everyone for your help and suggestions!!

my cousin works at a mental health place and she says thiss happens ALL THE TIME especially with inpatient facilities. EDD has like 3 different databases for facility verification and they dont talk to each other. its stupid but happens to lots of people

This is such a relief to hear that you got through and got it resolved! I'm dealing with a similar licensing issue with my SDI claim right now - got approved initially but then hit with a denial saying my treatment facility "doesn't meet requirements" even though they've been licensed for years. Your post gives me hope that it's just a database error. I'm definitely going to try Claimyr since calling directly has been impossible. Thanks for sharing your experience and keeping us updated - it really helps to know these issues can actually get fixed!

I'm going through something very similar right now! Got approved for SDI two weeks ago but then received a denial letter three days later citing "facility licensing verification issues" for the outpatient mental health clinic I'm receiving treatment at. The clinic administrator was just as confused as I was - they've been licensed and operating for over 8 years with no issues, and they have multiple other patients currently receiving disability benefits without problems. Reading through all these responses is honestly the first time I've felt hopeful about this situation. I had no idea this was such a common problem with EDD's outdated databases. I've been trying to call for over a week with zero success - just endless busy signals and "call back later" messages. @Diego Chavez thank you so much for sharing your experience and keeping everyone updated! Seeing that you actually got it resolved gives me hope. I'm definitely going to try the Claimyr service since direct calling seems impossible. Also going to ask my clinic to prepare all their licensing documentation including the NPI number as suggested. For anyone else dealing with this - it's reassuring to know we're not alone in this mess and that there are actual solutions that work!