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Back  RFI # 1642: Attempt Lookup-LN/FN Mult Hit

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Submitter

Jamie Dixon

Description

Would it be compliant/correct to return an AAA01=Y when multiple matches were found on the LN or FN(AAA03=73) and the data in the elements met the payer's requirements for format, data type, length and existence? We believe an AAA01=N would not be appropriate when no match is found because we believe an AAA01=N must only be returned if value sent in NM103/NM104(depending) required correcting by the provider per the payer's format, data type, length and/or existence requirements. Further, we believe there's a conflict if a match(with multiple hits) was made on LN or FN, and an AAA03=73 is returned. The "note" on the 73 code value specifically states it's to be used when the name did not produce a match or was missing. "Required when the transaction was rejected when the information source cannot find a match for the Subscriber Name submitted or if the Subscriber Name was missing." We believe the returning of AAA03=73 is in conflict with this note if returning when multiple matches on LN or FN have been made.

Submitter Assigned Keywords

LN/FN-Search/Match-Multiple Hits

Response

Yes it would be compliant/correct to return the AAA01 = Y when multiple matches were found on the LN or FN (AAA03=73) but data in the element met the payer's requirements for format, datatype, length and existence. It would not be compliant to return an AAA01=N when the data exists, and meets the payer's specifications. An AAA01=N should only be returned when the payer's specifications have not been met (invalid) or the data does not exist but is expected (missing).

Further, the note on AAA 73 would make it's use non-compliant with this TR3 when there are duplicates found. The AAA03 = 76 must be returned, when multiple matches were made on the ID.
Submission 7/24/2012
Status Date 9/21/2012
Status F - Final
Primary References
Document 005010X279
Section3
Page262
Set ID271
Table2
Loop2100C
Segment Position0850
Segment IDAAA
Element Position01
Code ValueN