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Back  RFI # 1120: Notes on AAA 58 & 71

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Submitter

Boyle-Campbell Donna

Description

What AAA value s/b used when a contract assigned ID is the trigger, the IS matches an ID, but its assigned to more than 1 ind (such as an entire fam), looks at the DOB, finds no match. Our rules then look at the FN, finds either a 0, 1 or >1 match. We further compare the LN & then determine the error.
The statement "located an individual" implies that on the ID match, to more than 1 ind in a single fam, we s/n use the 58. The note on 58 says "may not” unlike the 71s "must” be returned. The note on 71 referring to "located an individual" seems to give flexibility to use the 58 b/c 58 "invalid/missing DOB" does not imply that the patient was found, & the DOB happen to match another patient on the DB (in this case, the same fam), rather, 58 clearly implies the ind was NOT found.
71 = match to a single person but DOB didn’t match, 58 = can't pick b/c match >1 person. Is it OK to use 58 when you can’t determine the member starting with a mismatch on the DOB, cuz you matched more than one ind based on the ID?

Response

If the contract assigned ID is not unique to an individual, and the date of birth search does not result in a single match, the 2100 C/D AAA03 value of 58 (Invalid/Missing Date of Birth) is a valid value to return as you cannot determine if a patient date of birth mismatch has occurred, a single match has not been made on the unique contract assigned ID, and the last name and/or first name hasn’t narrowed the match.

If the ID search first had resulted in a single match to a single person, and therefore “located an individual,” but the date of birth was different, the 2100 C/D AAA03 58 must not be returned, and the 2100 C/D AAA03 value of 71 (Patient Birth Date does not match that for the Patient on the database) would be required.
Submission 8/2/2010
Status Date 9/24/2010
Status F - Final
Primary References
Document 005010X279
Section1.4.8
Page25
Set ID270271
Secondary References
RFI ID 1025
Document 005010X279
Section1.4.8
Page263
Set ID270271