Eligibility Error Messages
Change Healthcare Eligibility error messages and categories
Most providers’ offices ask for a considerable amount of information during the intake process for a new medical encounter. Since this by definition eliminates the possibility of sending a minimal query as an Eligibility request, accuracy in data entry is important for a successful Eligibility transaction. Avoid cutting corners in this area.
Error Message Formatting
Eligibility Error Message | Description |
---|---|
| Many error messages describe simple follow up actions and show the X12 loop where the incorrect field appears. For most errors, you can just correct the JSON field (in the request body) that's listed in the response, or edit using your console workflow. For some request fields, errors list the permissible values. If a data entry mistake occurs in this field, you’ll receive this error. Since a provider will often be of one specific type, the |
Required Value errors
Eligibility Error Message | Description |
---|---|
| If you submit a request body that’s missing a required value, you’ll receive a response similar to the following: The message also tells you which fields are permissible for identification. Here, you can provide |
| At a minimum, for the provider object, you must provide the |
| When you receive the following subscriber error, ensure the |
| This is a sample error for a request submitted with a mistake in the control number. It's a fundamental issue that must be fixed before a query can be processed. |
Understanding AAA errors
Payers are considered the Information Source for all eligibility queries, and this is the standard term in the medical industry. The provider submitting an eligibility query is called the Information Receiver.
AAA errors report on missing or invalid information from various parts of the submitted 270 Eligibility request. It's the standard error reporting system for all Eligibility transactions. AAA errors generate from seven different sections of eligibility queries:
- Information Source level - Errors in this category indicate problems or mistakes in reaching the query's specified recipients, such as the Interchange/clearinghouse ID (ISA06), or the payer (ISA08). The correct Interchange ID is important because the transaction you're submitting is used by both you, as the query sender, and the ultimate receiver of the query, who is the payer that will verify the insurance coverage. There might be a mistake in the Payer field, and the Interchange can't locate it in the payer network.
- Request Validation - Reports system errors such as more patient queries than the submitter is allowed to send; the query is being sent by a provider that isn't authorized to submit requests to the payer; the Payer is experiencing network problems or otherwise unable to receive and process the submission; and other causes.
- Information Receiver - Problems are detected in the request content defining the query sender - the Information Receiver of hoped-for insurance verification from the payer. You've got incorrect information in the
Provider
object, or possibly a missing PayerID. - Subscriber Request - There is incorrect content in the
Subscriber
object. A nicely detailed and extensive list of possible errors arises from this category. A significant one involvesInvalid /Missing Subscriber/Insured Name
which usually denotes the patient in the request doesn't have active insurance with the payer.Out of network
messages come from this category. - Subscriber Request Validation - The request contains subscriber information that caused problems with processing it, such as incorrect dates, or in some cases the payer requests more data.
- Dependent Request - There's incorrect or missing content for the dependent in the eligibility request. Many of the same error types you see for subscriber information also see usage here.
- Dependent Request Validation - The request contains dependent information that caused problems with processing it, such as incorrect dates. In some cases the payer requests more data.
Eligibility Error Message | Description |
---|---|
| The first error example is a Request validation error, showing the code The second error reports that correct Provider information is missing in the request. It is an error from the Information Receiver Request Validation AAA category. (Consult Page 243 of the ASC X12 Consolidated 270/271 Implementation Guide.) |
999 Errors
In the event of a 999 error, the error.code will be set to the 999 and the following information is mapped.
segment | element | field |
---|---|---|
IK | 301 | error.field Segment: %s |
IK | 302 | error.location the segment Loop: %s, Segment Position: %s |
IK | 303 | error.location the loop Loop: %s, Segment Position: %s |
IK | 304 | error.description |
IK | 40101-103,402,403,404 | error.followupAction Element Position in Segment: %s, Component Data Element Position in Composite: %s, Repeating Data Element Position: %s, Data Element Reference Number: %s, Implementation Data Element Syntax Error: %s, Copy of Bad Data Element: %s |
IK | 501 | response.transactionSetAcknowledgement |
IK | 502 | response.implementationTransactionSetSyntaxError |
Updated about 1 month ago