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

Required Value Errors

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

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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."
        }
    ]
}

2. 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."
},

3. 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."
        }
    ]
}`

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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.

• For a complete lis of AAA errors and descriptions, see AAA Errors
• See AAA Error Codes and Possible Resolutions
• See AAA Error Message Examples
• See AAA Error follow-up action codes

999 Errors

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

Related Topics

• Eligibility AAA Error Codes and Possible Resolutions
• Eligibility API FAQs