AAA Error Codes Requests and Possible Resolutions

This page provides some examples of AAA error codes and possible resolutions.

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 query is called the Information Receiver.

AAA errors report about 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 are generated from seven different sections of eligibility queries.
The Payer, Subscriber, Provider, and Dependent objects fall in the AAA error category.

AAA Error Category	Description
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 are 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` object and the Interchange could not 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 is not 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. There is incorrect information in the Provider object or possibly, a missing Payer ID.
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 involves Invalid/Missing Subscriber/Insured name, which usually denotes that the patient in the request does not have active insurance with the payer. The out-of-network messages are in 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 is incorrect or missing content for the dependent in the Eligibility request. Many of the same error types you see for subscriber information are also used 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 for more data.

Required value errors

If you submit a request body that is missing a required value, you will receive a response similar to the following: required parameter errors and descriptions.

AAA Error Message Examples

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "04",
  "AAA04": "C",
  "description": "Authorized quantity exceeded. 
  "followupAction": Reduce the number of requests or split into multiple transactions, or do  
   as instructed by payerthen resubmit."
},

{
  "AAA01": "N",  
  "AAA02": "",  
  "AAA03": "35",  
  "AAA04": "N",  
  "description": "Provider is out of network. Resubmission not allowed.",
  "followupAction": "Do Not Resubmit; Inquiry Initiated to a Third Party",
  "location": "Loop 2100C",
  "possibleresolution": Provider is not an in-network provider for the subscriber's plan.
},

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "42",
  "AAA04": "Y",
  "description": "Unable to respond at current time. Do not resubmit; payer will respond  
   when able."
  "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."
},

The following error examples report that the correct Provider information is missing in the request. It is an error from the Information Receiver Request Validation AAA error category (refer Page 243 of the ASC X12 Consolidated 270/271 Implementation Guide).

 {
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "43",
  "AAA04": "C",
  "description": "Invalid or missing provider identification." 
  "followupAction": "Add or correct provider ID and resubmit."
  "location": "Loop 2100D",
  "possibleResolutions": "Provider's NPI most likely is not registered with the payer, or   
   not registered correctly with the payer, and the provider must contact payer directly to 
   correct, Optum cannot do this for them, it is a PHI/HIPPA restriction"
},

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "45",
  "AAA04": "C",
  "description": "Invalid or missing provider specialty. 
  "followupAction": Please add or correct the provider specialty code and resubmit the 
   transaction.",
  "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."
},

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "47",
  "AAA04": "C",
  "description": "Invalid or missing provider state."
  "followupAction": "Please add or correct the provider's state code and resubmit the 
   transaction.",
  "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."
},

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "48",
  "AAA04": "C",
  "description": "Invalid or missing provider postal code.",
  "followupAction": "Please add or correct the provider's ZIP/postal code and resubmit the 
   transaction.","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 Optum is  
   incorrect, contact enrollment department."
}

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "49",
  "AAA04": "N",
  "description": "Provider is not the primary care physician (PCP).",
  "followupAction": Resubmission not allowed. Please verify the PCP or contact the payer   
   for further instructions.
  "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. Optum can not 
   do this due to PHI/HIPPA guidelines."
},

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "51",
  "AAA04": "N",
  "description": "Provider not on file. Resubmission not allowed.",
  "followupAction": "Please register the provider with the payer or use a provider that is 
   already on file.",
  "location": "Loop 2100C",
  "possibleResolutions": "Provider is not registered with the payer, provider must call  
   payer directly to register their NPI"
},

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "52",
  "AAA04": "C",
  "description": "Service dates are not within the provider's plan enrollment period."
  "followupAction": Please adjust the service dates to match the provider's enrollment  
   period and resubmit the transaction.
  "location": "Loop 2100D",
  "possibleResolutions": "Provider was not registered in the insured's plan with the payer, 
   on the DOS listed in transaction."
},

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "57",
  "AAA04": "C",
  "description": "Invalid or missing date(s) of service.",
  "followupAction": "Add or correct and resubmit.",
  "location": "Loop 2100D",
  "possibleResolutions": "DOS is not within allowable time frame, or DOS is missing in the 
   270"
},

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "63",
  "AAA04": "C",
  "description": "Invalid or missing referring provider identification."
  "followupAction": "Please add or correct the referring provider's ID and resubmit the 
   transaction.",
  "location": "Loop 2100C",
  "possibleResolutions": "Some Payers do not accept DOS in the future check payer  
   instruction tables for specs per payer."
},

The following error examples report that the correct Patient information is missing in the request. It is an error from the Information Receiver Request Validation AAA error category (refer Page 243 of the ASC X12 Consolidated 270/271 Implementation Guide).

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "72",
  "AAA04": "C",
  "description": "Invalid or missing subscriber/insured ID.",
  "followupAction": "Please add or correct the subscriber or insured's identification number 
   and resubmit the transaction.",
  "location": "Loop 2100C",
  "possibleResolutions": "Subscriber member ID is incorrect in the request being sent."
},

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "76",
  "AAA04": "C",
  "description": "Duplicate subscriber/insured ID number.",
  "followupAction": "Please use a unique subscriber or insured ID and resubmit the 
   transaction.",
  "location": "Loop 2100C",
  "possibleResolutions": "Duplicate member ID is found in the payer database."
},

The following error example is a Request validation error, showing code T4 describing that the request is missing correct payer information whether it is the correct payerName or payerId. Because the submitter (the Information Receiver) has authorization to do business with the payer, the message Resubmission Allowed signals that the provider can fix the problem and try again.

{
  "AAA01": "N",
  "AAA02": "",
  "AAA03": "T4",
  "AAA04": "C",
  "description": "Payer name or identifier is missing.",
  "followupAction": "Please add or correct the payer's name or ID and resubmit the 
   transaction.", 
  "location": "Loop 2100A",
  "possibleResolutions": "Payer Name or Identifier Missing."
},

AAA Rejection codes are part of the Eligibility standard, but since that standard is licensed, we are limited in what we can show. Most are clear when they are defined, such as AAA 72 for Invalid/Missing Subscriber/Insured ID. That basically means that the memberId in the request does not have a match with the payer.

A couple others that might be nuclear:

AAA 41 — Authorization/Access Restrictions: This is an enrollment issue where the NPI in the request needs to be recognized by the payer. You can check enrollment requirements on our payer list, and complete the enrollment form through Enrollment Central. This may also be represented with AAA 79 for Invalid Participant Identification.
AAA 42/80 — These indicate something is wrong like a transaction time out or an exception that does not fit in other AAA codes. Most of the time, these are temporary and will resolve on their own. If you continue to get this error on a request, you should open a support ticket.

The complete list of AAA codes and Eligibility request and response codes can be purchased here.

AAA Error Codes and Possible Resolutions

AAA Error Code	Reason for Rejection	Possible Resolution
04	Authorized Quantity Exceeded	This code is returned when the quantity requested in the original 270 Eligibility Inquiry exceeds the maximum allowed by the payer or information source. Review the transaction limits; reduce the number of requests or split into multiple transactions or do as instructed by payer.
15	Required Application Data Missing	Payer search criteria is not met. Problem at payer. Search criteria is set up incorrectly on Optum side.
33	Input Errors	The payer is signaling that the 270 Eligibility Inquiry contained invalid or missing data required for processing. Common causes include: Missing required fields (e.g., patient name, DOB, member ID, provider NPI). Incorrect data formats (e.g., invalid date format or member ID).
35	Out of Network	Provider is not an in-network provider for the subscriber's plan.
41	Authorization/Access Restrictions	If it comes before the 2000A loop, it is most likely an enrollment issue with the vendor or provider's tax ID. If it comes after the 2000A or after the 2000B loop, it is an enrollment issue. Issue with payer assigned log in ID. Incorrect/missing portal payer credentials.
42	Unable to Respond at Current Time
43	Invalid/Missing Provider Identification	Provider's NPI is not registered with the payer. Provider's NPI not registered correctly with the payer. Payer requires an agreement.
44	Invalid/Missing Provider Name	Provider's NPI is registered with incorrect name at the payer. Provider must contact the payer directly to have this issue fixed because of PHI/HIPPA guidelines.
45	Invalid/Missing Provider Specialty	Provider's NPI not registered with the payer under correct Specialty. Provider must contact payer directly to remedy this issue, due to PHI/HIPPA guidelines.
46	Invalid/Missing Provider Phone Number	Provider's phone does not match what is registered with the payer or the NPPES system for this provider. Provider must contact payer directly to remedy this issue, due to PHI/HIPPA guidelines.
47	Invalid/Missing Provider State	Provider's address does not match what is listed with the payer or the NPPES system. Provider must contact payer directly to remedy this issue, due to PHI/HIPPA guidelines.
49	Provider is Not Primary Care Physician	Provider must be PCP in some payer plans. Insured must contact payer and set PCP in their system, Optum cannot do this due to PHI/HIPPA guidelines.
51	Provider Not on File	Provider is not registered with the payer, provider must call payer directly to register their NPI.
52	Service Dates Not Within Provider Plan Enrollment	Provider was not registered in the plan of the insured with the payer, on the Date-of-Service (DOS) listed in transaction.
53	Inquired Benefit Inconsistent with Provider Type	Provider submitting a transaction for specialty that they are not registered with the payer to perform.
54	Inappropriate Product/Service ID Qualifier	Please use a valid qualifier (such as 'HC' for CPT/HCPCS, 'AD' for ADA codes, etc.) and resubmit the transaction.
55	Inappropriate Product/Service ID	Invalid procedure code.
56	Inappropriate Date	Incorrect date. Incorrect date format.
57	Invalid/Missing Date or Service	Date-of-service (DOS) is not within allowable time frame. DOS is not included in the 270. DOS is in the future.
58	Invalid/Missing Date-of-Birth (DOB)	DOB is not included in 270. DOB is incorrect in 270.
59	Invalid/Missing DOD	Insured has died and the DOD is either incorrect or missing from transaction.
60	DOB Follows DOS	DOS is before the DOB in which case, the transaction should be submitted with the mother's information.
61	Date of Death (DOD) Precedes DOS	Insured died before DOS listed in the transaction, provider must correct and resubmit.
62	DOS Not Within Allowable Inquiry Period	DOS is outside of the accepted time frame for requests to be submitted for the payer.
63	DOS in the future	Some Payers do not accept DOS in the future check payer instruction tables for specs per payer.
64	Invalid/Missing Patient ID	Patient ID is missing and required by payer. Patient ID is incorrect in the request and needs to be verified with a copy of insurance card.
65	Invalid/Missing Patient Name	Patient name is not included in the request (270). Patient name is spelled differently in the payer database than the provider entered into the request (270).
66	Invalid/Missing Patient Gender Code	Invalid/missing gender type code. Invalid/missing patient.
67	Patient Not Found	Patient is not in the payer's database. Patient is not included in the Data File used for hosting.
68	Duplicate Patient ID Number	There is either a different patient with the same member ID in the payer's database or in the hosted data file.
69	Inconsistent with Patient's Age	When Diagnoses codes are inconsistent with patient's age.
70	Inconsistent with Patient's Gender	Procedure codes are inconsistent with patient's gender.
71	Patient DOB Does Not Match That for the Patient on the Database	DOB sent in request does not match that in the payer's database, the subscriber will need to contact the payer to have this changed.
72	Invalid/Missing Subscriber/Insured ID	Subscriber member ID is incorrect in the 270 request. Request does not meet the payer requirements for subscriber ID.
73	Invalid/Missing Subscriber/Insured Name	Incorrect subscriber name submitted. Subscriber name missing. Subscriber name spelled incorrectly. Request is not meeting payer requirements for subscriber name.
74	Invalid/Missing Subscriber/Insured Gender Code	Subscriber's gender code was not submitting. An invalid character. Incorrect gender code.
75	Subscriber/Insured Not Found	Subscriber was not found for a direct connect payer. Subscriber not found in payers.
76	Duplicate Subscriber/Insured ID Number	Duplicate member ID is found in the payer database.
77	Subscriber Found: Patient Not Found	Subscriber was found in payer's database but the dependent's information is not in the payer's database.
78	Subscriber/Insured Not in Group/Plan identified	Normally, for Coventry payers where, request is sent to the incorrect payer plan database and the correct Group/Plan is listed in 271 in the LS2120 segment.
79	Invalid Participant Identification	NPI in the 270 request is not on file with the payer.
80	No Response received - Transaction Terminated	Payer processing issue. Transaction timed out. Payer sent invalid 271 response.
84	Certification Not Required for this Service	No action required.
90	Requested Information Not Received	Provide the requested information and resubmit.
95	Patient Not Eligible	Patient not eligible. Verify eligibility and contact payer if needed.
97	Invalid or Missing Provider Address	Provider address is missing or invalid. Add or correct and resubmit.
T4	Payer Name or Identifier Missing	Payer name or identifier is missing. Add or correct and resubmit.
AG	Invalid/Missing Procedure Code(s)	Procedure code is missing or invalid. Add or correct and resubmit.
AH	Invalid/Missing Onset of Current Condition or Illness Date	Onset date is missing or invalid. Add or correct and resubmit.
AI	Invalid/Missing Accident Date	Accident date is missing or invalid. Add or correct and resubmit.
AJ	Invalid/Missing Last Menstrual Period Date	LMP date is missing or invalid. Add or correct and resubmit.
AK	Invalid/Missing Expected Date of Birth	Expected date of birth is missing or invalid. Add or correct and resubmit.
AM	Invalid/Missing Admission Date	Admission date is missing or invalid. Add or correct and resubmit.
AN	Invalid/Missing Discharge Date	Discharge date is missing or invalid. Add or correct and resubmit.
IP	Inappropriate Provider Role	Use appropriate provider role for the request.

AAA Error follow-up action codes

Code	Message
C	Please Correct and Resubmit
N	Resubmission Not Allowed
P	Please Resubmit Original Transaction
R	Resubmission Allowed
S	Do Not Resubmit; Inquiry Initiated to a Third Party
W	Please Wait 30 Days and Resubmit
X	Please Wait 10 Days and Resubmit
Y	Do Not Resubmit; we Will Hold Your Request and Respond Again Shortly