AAA

Service Request Validation

Pos: 030	Max: 9
Detail - Optional
Loop: 2000F	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. For example, use for missing procedure codes and procedure dates.

33

Input Errors

Use for input errors in the service data not covered by the other reject reason codes listed. For example, use for invalid place of service codes and invalid procedure codes and procedure dates.

52

Service Dates Not Within Provider Plan Enrollment

57

Invalid/Missing Date(s) of Service

Use for invalid/missing service, admission, surgery, or discharge dates.

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

T5

Certification Information Missing

Use to indicate missing previous certification number information.

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. Required if the request is not valid at this level to indicate the data condition that prohibits processing of the original request.
2. If the non-certification is related to a medical necessity/benefits decision, use the HCR segment.
3. If Loop 2000F is present, either the AAA segment or the HCR segment must be returned.

Example:

AAA*N**52*C~