Eligibility AAAError Codes and Possible Resolution

This page provides some examples of AAAError codes and possible resolutions.

Code 04

{
  "field": "AAA",
  "code" : "04",
  "description": "Authorized Quantity Exceeded",
  "followupAction": "Please Correct and Resubmit",
 }

Code 35

{
   "field": "AAA",
   "code": "35",
   "description": "Out of Network",
   "followupAction": "Do Not Resubmit; Inquiry Initiated to a Third Party",
   "location": "Loop 2100C",
   "possibleResolutions": "Provider is not in network provider for the subscriber's plan"
},

Code 42

{
  "field": "AAA",
  "code": "42",
  "description": "Unable to Respond at Current Time",
  "followupAction": "Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly",
  "location": "Loop 2100C",
  "possibleResolutions": "Is what we call the catch-all error.First place to start is look at PIRs to see if payer is having issues processing. If no PIR for payer call Command Center and have them check the system see if they are seeing trouble with the payer.Follow standard troubleshooting flow if no issue happening with payer."
},

Code 45

{
  "field": "AAA",
  "code": "45",
  "description": "Invalid/Missing Provider Specialty",
  "followupAction": "Please Wait 30 Days and Resubmit",
  "location": "Loop 2100D",
  "possibleResolutions": "Provider's NPI not registered with the payer under the correct Specialty. Provider must contact payer directly to remedy this issue, due to PHI/HIPPA."
},

Code 47

{
  "field": "AAA",
  "code": "47",
  "description": "Invalid/Missing Provider State",
  "followupAction": "Please Correct and Resubmit",
  "location": "Loop 2100D",
  "possibleResolutions": "Provider's address doesn't match what is listed with the payer or the NPPES system. Provider must contact payer directly to remedy this issue, due to PHI/HIPPA."
},

Code 48

{
  "field": "AAA",
  "code": "48",
  "description": "Invalid/Missing Referring Provider Identification Number",
  "followupAction": "Do Not Resubmit; Inquiry Initiated to a Third Party",
  "location": "Loop 2100D",
  "possibleResolutions": "Referrals only: Referring provider's NPI is either not registered with the payer, provider must contact payer directly, or Enrollment with Emdeon is incorrect, contact enrollment department."
},

Code 49

{
  "field": "AAA",
  "code": "49",
  "description": "Provider is Not Primary Care Physician",
  "followupAction": "Resubmission Not Allowed",
  "location": "Loop 2100D",
  "possibleResolutions": "Referrals only: Referring provider must be Primary Care Physician in some payer plans, insured must contact payer and set PCP in their system. Emdeon can not do this due to PHI/HIPPA guidelines."
},

Code 51

{
  "field": "AAA",
  "code": "51",
  "description": "Provider Not on File",
  "followupAction": "Please Correct and Resubmit",
  "location": "Loop 2100C",
  "possibleResolutions": "Provider is not registered with the payer, provider must call payer directly to register their NPI"
}

Code 52

{
  "field": "AAA",
  "code": "52",
  "description": "Service Dates Not Within Provider Plan Enrollment",
  "followupAction": "Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly",
  "location": "Loop 2100D",
  "possibleResolutions": "Provider was not registered in the insured's plan with the payer, on the DOS listed in transaction."
},

Code 57

{
  "field": "AAA",
  "code": "57",
  "description": "Invalid/Missing Date(s) of Service",
  "followupAction": "Do Not Resubmit; We Will Hold Your Request and Respond Again Shortly",
  "location": "Loop 2100D",
  "possibleResolutions": "DOS is not within allowable time frame, or DOS is missing in the 270"
}

Code 63

{
  "field": "AAA",
  "code": "63",
  "description": "Date of Service in Future",
  "followupAction": "Please Wait 30 Days and Resubmit",
  "location": "Loop 2100C",
  "possibleResolutions": "Some Payers do not accept DOS in the future check payer instruction tables for specs per payer."
},

Code 72

{
  "field": "AAA",
  "code": "72",
  "description": "Invalid/Missing Subscriber/Insured ID",
  "followupAction": "Please Correct and Resubmit",
  "location": "Loop 2100C",
  "possibleResolutions": "Subscriber member ID is incorrect in the request being sent."
},

Code 76

{
  "field": "AAA",
  "code": "76",
  "description": "Duplicate Subscriber/Insured ID Number",
  "followupAction": "Resubmission Not Allowed",
  "location": "Loop 2100C",
  "possibleResolutions": "Duplicate member ID is found in the payer database."
},

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