AAA

Service Provider Request Validation

Pos: 230	Max: 9
Detail - Optional
Loop: 2010E	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 when there is not enough information to identify the service provider.

33

Input Errors

Use for input errors not covered by another reject reason code.

35

Out of Network

41

Authorization/Access Restrictions

43

Invalid/Missing Provider Identification

44

Invalid/Missing Provider Name

45

Invalid/Missing Provider Specialty

46

Invalid/Missing Provider Phone Number

47

Invalid/Missing Provider State

49

Provider is Not Primary Care Physician

51

Provider Not on File

52

Service Dates Not Within Provider Plan Enrollment

79

Invalid Participant Identification

Use for invalid/missing service provider supplemental identifier.

97

Invalid or Missing Provider Address

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

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. Use this segment to convey rejection information regarding the service provider.
2. Required only if the request is not valid at this level.

Example:

AAA*N**43*C~