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Back  RFI # 1625: 999 or AAA

Formal vs. Informal Help Informal Formal

Submitter

Deb McCachern

Description

If a health plan does not support the qualifier “SY,” is it allowable for the health plan to return a 999 rather than a AAA when "SY" is received in the 5010 270 2100C/D REF01?

The x279 guide states, , "the Implementation Acknowledgment (999) transaction is required only if a real-time transaction is rejected for Implementation Guide errors that connot otherwise be reported in a 271 AAA segment." However, there is no 2100C/D AAA03 value in the 271 that seems appropriate. Please advise.

Submitter Assigned Keywords

999 AAA

Response

It would not be allowable to return either the 999 or a 271 with an AAA segment to reject a 270 transaction simply because data was sent in the 270 if the segment and/or element’s situational rule was satisfied. The 005010X279 TR3 Section 1.4.8 Search Options states “Unlike many other X12 transactions, the 270 transaction has the built in flexibility of allowing a user to enter whatever patient information they have on hand to identify them to an information source.” The purpose of this is so the provider does not have to customize the information that is submitted for each payer. Anything not used by the information source must be ignored.

While this RFI did not specifically ask about the note associated with code SY, and it was confirmed with the requestor that this note did not apply in their scenario, this response does not address whether the transaction can or cannot be rejected based on that note.
Submission 7/13/2012
Status Date 4/30/2013
Status F - Final
Primary References
Document 005010X279
Section2
Set ID271
Loop2100
Segment IDREF
Element Position01