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Back  RFI # 1644: Attempt Lookup- MID/LN/FN Mult

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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 MID and the LN (AAA03=73), but the FN happened to not match, 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 mutliple matches are found because we believe an AAA01 = N must only be returned if value sent in NM103, NM104 and/or NM109 required correcting by the provider per the payer's format, data type, length and/or existence requirements. Further, because multiple matches were made on the MID, wouldn't it be required to return AAA03=76 (Duplicate Subscriber/Insured ID)?

Submitter Assigned Keywords

MID/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 MID and the LN (AAA03=73). 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 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
Secondary References
RFI ID 2108
Document 005010X279
Section3
Page262
Set ID271
Table2
Loop2100C
Segment Position0850
Segment IDAAA
Element Position03
Code Value76