AAA

Dependent Request Validation

Pos: 085	Max: 9
Detail - Optional
Loop: 2100D	Elements: 3

Ref

Id

Element Name

Req

Type

Min/Max

Usage

AAA01

1073

Yes/No Condition or Response Code
Description: Code indicating a Yes or No condition or response
Industry: Valid Request Indicator

M

ID

1/1

Required

Code

Name

N

No

Y

Yes

AAA03

901

Reject Reason Code
Description: Code assigned by issuer to identify reason for rejection
Use this code for the reason why the transaction was unable to be processed successfully. This may indicate problems with the system, the application, or the data content.
Use codes “43", ”45", “47", ”48", or “51" only in response to information that is in or should be in the PRV segment in the Dependent Name loop (2100D).

O

ID

2/2

Required

Code

Name

15

Required application data missing

42

Unable to Respond at Current Time

Use this code in a batch environment where an information source returns all requests from the 270 in the 271 and identifies “Unable to Respond at Current Time” for each individual request (subscriber or dependent) within the transaction that they were unable to process for reasons other than data content (such as their system is down or timed out in generating a response). Use only codes “R”, “S”, or “Y” for AAA04.

43

Invalid/Missing Provider Identification

45

Invalid/Missing Provider Specialty

47

Invalid/Missing Provider State

48

Invalid/Missing Referring Provider Identification Number

49

Provider is Not Primary Care Physician

51

Provider Not on File

52

Service Dates Not Within Provider Plan Enrollment

56

Inappropriate Date

57

Invalid/Missing Date(s) of Service

58

Invalid/Missing Date-of-Birth

60

Date of Birth Follows Date(s) of Service

61

Date of Death Precedes Date(s) of Service

62

Date of Service Not Within Allowable Inquiry Period

63

Date of Service in Future

64

Invalid/Missing Patient ID

65

Invalid/Missing Patient Name

66

Invalid/Missing Patient Gender Code

67

Patient Not Found

68

Duplicate Patient ID Number

71

Patient Birth Date Does Not Match That for the Patient on the Database

AAA04

889

Follow-up Action Code
Description: Code identifying follow-up actions allowed
Use this code to instruct the recipient of the 271 about what action needs to be taken, if any, based on the validity code and the reject reason code (if applicable).

O

ID

1/1

Required

Code

Name

C

Please Correct and Resubmit

N

Resubmission Not Allowed

R

Resubmission Allowed

Use only when AAA03 is “42".

S

Do Not Resubmit; Inquiry Initiated to a Third Party

W

Please Wait 30 Days and Resubmit

X

Please Wait 10 Days and Resubmit

Y

Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly

Use only when AAA03 is “42".

1.

AAA01 designates whether the request is valid or invalid. Code "Y" indicates that the code is valid; code "N" indicates that the code is invalid.

1.

If AAA02 is used, AAA03 contains a code from an industry code list.

Notes:

1. Use this segment when a request could not be processed at a system or application level and to indicate what action the originator of the request transaction should take.
2. Use this segment to indicate problems in processing the transaction specifically related to the data contained in the original 270 transaction’s dependent name loop (Loop 2100D).

Example:

AAA*N**72*C~