AAA

Subscriber Request Validation

Pos: 230	Max: 9
Detail - Optional
Loop: 2010CA	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

15

Required application data missing

Use when data is missing that is not covered by another Reject Reason Code. Use to indicate that there is not enough data to identify the subscriber.

58

Invalid/Missing Date-of-Birth

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

72

Invalid/Missing Subscriber/Insured ID

73

Invalid/Missing Subscriber/Insured Name

74

Invalid/Missing Subscriber/Insured Gender Code

75

Subscriber/Insured Not Found

76

Duplicate Subscriber/Insured ID Number

77

Subscriber Found, Patient Not Found

78

Subscriber/Insured Not in Group/Plan Identified

79

Invalid Participant Identification

Use for invalid/missing subscriber supplemental identifier.

95

Patient Not Eligible

AAA04

889

Follow-up Action Code
Description: Code identifying follow-up actions allowed
Required if AAA03 is present and indicates that the rejection is due to invalid or missing subscriber or patient data.

O

ID

1/1

Situational

Code

Name

C

Please Correct and Resubmit

N

Resubmission Not Allowed

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. Required only if the request is not valid at this level.

Example:

AAA*N**67~