AAA

Utilization Management Organization (UMO) Request Validation

Pos: 230	Max: 9
Detail - Optional
Loop: 2010A	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
Required if AAA01 = “N”.

O

ID

2/2

Situational

Code

Name

04

Authorized Quantity Exceeded

Use this code to indicate that the transaction exceeds the maximum number of patient events for this information source (UMO). This implementation guide limits each transaction to a single patient event.

41

Authorization/Access Restrictions

Use this reason code to indicate that the sender, as identified in ISA06 or GS02 is not authorized to send the transaction sets identified in GS01 or transaction sets with the purpose identified in BHT02 to the information source (UMO) identified in Loop 2010A. The 278 transaction set has three different implementations. The transaction set purpose as identified in BHT02 specifies the implementation.

42

Unable to Respond at Current Time

Use this code to indicate that the information source (UMO) identified in Loop 2010A is unable to process the transaction at the current time. This indicates that there is a problem within the UMO’s system.

79

Invalid Participant Identification

Use this code to indicate that the code used in Loop 2010A to identify the information source (UMO) is invalid.

80

No Response received - Transaction Terminated

Use this code to indicate that the trading partner/application system responsible for sending the request to the information source (UMO) has not received a response in the expected timeframe and therefore has terminated the request.

T4

Payer Name or Identifier Missing

Use this code to indicate that either the name or identifier for the information source (UMO) identified in Loop 2010A is missing.

AAA04

889

Follow-up Action Code
Description: Code identifying follow-up actions allowed
Required if AAA03 is present.

O

ID

1/1

Situational

Code

Name

N

Resubmission Not Allowed

P

Please Resubmit Original Transaction

Y

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

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 AAA segment to report the reasons why the request cannot be processed at a system or application level based on the Utilization Management Organization (information source) identified in Loop 2010A
2. Required only if the request is not valid at this level.

Example:

AAA*N**42*Y~