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Back  RFI # 2153: 278 AAA for unsupported UM01

Formal vs. Informal Help Informal Formal

Submitter

Deb McCachern

Description

This question relates to the 278X217. A payer only supports a 2000E UM01 value of SC. When a provider submits HS, the response returned is 2000A AAA79. Is this a valid response in this situation? We feel the error should be returned at the 2000E AAA level.

Is it compliant to return a 2000A AAA79 in this situation? If not, where should the AAA be reported and what error message should be used. (AAA33?)

Response

When an entity's business is specific to referrals and does not process authorizations, a trading partner agreement or companion guide identifies that business to their trading partners. Returning a AAA03 = 79 is not a valid response at the 2000A loop as this code indicates an error at the GS level and there may be multiple 278 transactions per GS.

The guide is specific, an error is reported at the level the error occurred. If a submitter sends a code value in UM01 at the 2000E patient event level other than SC (Specialty Care Review), a rejection code of AAA03 - 33 at the 2000E patient event level should be used to indicate the rejection of the transaction.

If the business required a more specific reason for the rejection, a change request should be submitted to create a new code value for use in the AAA03 element.
Submission 6/3/2016
Status Date 9/29/2016
Status F - Final
Primary References
Document 005010X217
SectionResponse