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Back  RFI # 447: 271 2100A AAA03=80 code usage

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Submitter

KEN EDICK

Description

A BCBS company is implementing an error code that is defined in the IG for clearinghouse and VAN usage. From the IG the code description for the 2100A AAA03 code 80 is "No Response received - Transaction Terminated,Use this code only if the transaction is processed by a clearing house, VAN, etc. Use this code to indicate that the transaction was sent to the Information Source Identified in Loop 2100A however no response was received in the expected time frame."

The payer is assuming that since they forward the 270 to the BX for the remote Blue that they are a clearinghouse. The description stipulates that "the transaction was sent to the Information Source Identified in Loop 2100A". Since the provider sends their 270 to the local BCBS company, the Information Source is the local Blue even if they have to send it to BX to get it to the remote Blue company. In this scenario, I would argue that this is a private network operated by the Blue Plans and is not a clearinghouse.

Is this usage appropriate?

Submitter Assigned Keywords

271 AAA

Response

004010X092A1 271 2100A AAA Segment Note 2 states “Use this segment to indicate problems in processing the transaction specifically related to the information source data contained in the original 270 transaction’s information source name loop (Loop 2100A) or to indicate that the information source itself is experiencing system
problems.”

AAA03 code 80 also contains the following “Use this code to indicate that the transaction was sent to the Information Source Identified in Loop 2100A however no response was received in the expected time frame.”

If the payer the transaction is being routed to is identified in the 270 2100A, then use of 2100A AAA03 = “80” is appropriate.

If the payer identified in the 270 2100A is the local Blue and not the payer that is ultimately routed to, 2100A AAA03 = “80” is not appropriate.

Recommendation

Since it appears that the local Blue is identified as the Information Source in 2100A, even though it is relying on external data, 2100A AAA03 = “42” (Unable to Respond at Current Time) is the most appropriate message.

The work group will investigate the need for an additional code to indicate that the transaction was routed by the entity identified in Loop 2100A to an external source and that external source is not responding. This will be investigated for future Implementation Guidelines.
Submission 9/6/2006
Status Date 11/10/2006
Status F - Final
Primary References
Document 004010X092A1
Section3
Page174
Set ID271
Loop2100A
Segment Position085
Segment IDAAA
Element Position03
Code Value80