Eligibility Error Messages

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

Error MessageDescription
{ "field": "provider.validProviderCode", "description": "Allowed Values are: 'AD' Admitting, 'AT' Attending, 'BI' Billing, 'CO' Consulting, 'CV' Covering, 'H' Hospital, 'HH' Home Health Care, 'LA' Laboratory, 'OT' Other Physician, 'P1' Pharmacist, 'P2' Pharmacy, 'PC' Primary Care Physician, 'PE' Performing, 'R' Rural Health Clinic, 'RF' Referring, 'SB' Submitting, 'SK' Skilled Nursing Facility, 'SU' Supervising" }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 is 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 will receive this error. Since a provider will often be of one specific type, the providerCode value should be a commonly understood value among provider employees whose job involves claims processing. Since providerCode is an optional value, consider removing optional values from the request before re-sending. Depending on the data that is needed to fully define the procedure for payer analysis, this may not be an option.

Required Value Errors

If you submit a request body with a required value missing, you will receive a response similar to the following:

📘

NOTE

For more information, please see Contents of the Eligibility Request Body.

The message also tells you which fields are permissible for identification.

  1. In the following example, provide organizationName or firstName and lastName for the medical provider.
{
    "provider":
        {
            "firstName": "medical",
            "lastName": "group",
            "npi": "0123456789"
        },
}

At a minimum, for the provider object, you must provide npi and organizationName. If the provider is an individual, firstName and lastName are both required.

{
    "errors": [
        {
            "field": "AAA",
            "code": "44"
            "description": "Invalid/Missing Provider Name",
            "followupAction": "Please Correct and Resubmit",
  					"location": "Loop 2100D",
  					"possibleResolutions": "Provider's OrganizationName or LastName is required."
        }
    ]
}
  1. When you receive the following subscriber error, ensure the dateOfBirth field is formatted correctly. You may see more than one error for the related issue because the wrongly formatted date will also show up as an incorrect value against the payer database.
{
   "field": "subscriber.dateOfBirth",
   "description": "Invalid date format. 
                   Please use the following format:
                   yyyyMMdd."
}
{
   "field": "AAA",
   "code": "71",
   "description": "Patient Birth Date Does Not Match 
                   That for the Patient on the Database",
   "followupAction": "Please Correct and Resubmit",
   "location": "Loop 2100C"
   "possibleResolutions": "Patient Birth Date Does Not Match That for the Patient on the Database."
},
  1. The following is an error example for a request submitted with an error in the patientId. It is a fundamental issue that must be fixed before a query can be processed.
{
   "field": "patientId",
   "description": "Invalid/Missing Patient ID."
}
`{
    "errors": [
        {
            "field": "AAA",
            "code": "64"
            "description": "Invalid/Missing Patient ID"
            "followupAction": "Please Correct and Resubmit",
   					"location": "Loop 2100C"
   					"possibleResolutions": "Patient ID is incorrect in the request being sent."
        }
    ]
}`

📘

NOTE

See JSON-to-EDI API mapping for more information.

Eligibility API AAA Errors

Payers are considered the Information Source for all Eligibility inquiries, and this is the standard term in the medical industry. The provider submitting an Eligibility inquiry is called the Information Receiver.

AAA Errors report on missing or invalid information from various parts of the submitted 270 Eligibility request and show possible resolutions. It is the standard error reporting system for all the Eligibility transactions. AAA Errors generate from seven different sections of Eligibility inquiries.
Payer, Subscriber, Provider, and Dependent objects fall in the AAA Error category.

999 Errors

In the event of a 999 error, the error.code will be set to the 999 and the following information is mapped.

SegmentElementField
IK204error.description
IK301error.field

Segment: %s
IK302error.location

the segment

Loop: %s, Segment Position: %s
IK303error.location

the loop

Loop: %s, Segment Position: %s
IK304error.description
IK400error.description
Bad Request
IK40101-103,402,403,404error.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.
  • IK405error.description
    The method specified in the Request-Line is not allowed for the resource identified by the Request-URI.
    IK406error.description
    Not Acceptable
    IK500error.description
    Internal Server Error
    IK501response.transactionSetAcknowledgement
    IK502response.implementationTransactionSetSyntaxError
    IK503error.description
    Service Unavailable, resources down

    Related Topics