Prior Auth AAA Error Codes Requests and Possible Resolutions

This page provides some examples of the Prior Authorization's AAA error codes and possible resolutions.

AAA Errors

Payers are considered the Information Source for all Prior Authorization inquiries, and this is the standard term in the medical industry. The provider submitting a query is called the Information Receiver.

AAA errors report about missing or invalid information from various parts of the submitted request and show possible resolutions. It is the standard error reporting system for all the transactions. AAA errors are generated from seven different sections of Prior Authorization 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 Prior Authorization 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

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "04",    
  "rejectReasonDescription": "Authorized Quantity Exceeded",    
  "rejectReasonExplanation": "The request is for more units than the maximum allowed by the    
   plan.",
  "followupActionCode": "C"
}
]

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "35",    
  "rejectReasonDescription": "Out of Network",    
  "rejectReasonExplanation": "Out of network.",
  "followupActionCode": "C"
}
]

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "42",    
  "rejectReasonDescription": "Unable to Repond at Current Time",    
  "rejectReasonExplanation": "The payer's system is undergoing maintenance and cannot process 
   the request right now.  Try again later.",
  "followupActionCode": "C"
}
]

The following error example reports that the correct Provider information is missing in the request. It is an error from the Information Receiver Request Validation AAA error category.

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "43",    
  "rejectReasonDescription": "Invalid/Missing Provider Identification",    
  "rejectReasonExplanation": "npi is missing or does not match the payer's records.",
  "followupActionCode": "C"
}
]

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "45",    
  "rejectReasonDescription": "Invalid/Missing Provider Specialty",    
  "rejectReasonExplanation": "The provider's specialty code is missing or not recognized by 
   the payer.",
  "followupActionCode": "C"
}
]

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "47",    
  "rejectReasonDescription": "Invalid/Missing Provider State",    
  "rejectReasonExplanation": "The provider's state code is missing or not recognized by the 
   payer.",
  "followupActionCode": "C"
}
]

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "49",    
  "rejectReasonDescription": "Provider is Not Primary Care Physician",    
  "rejectReasonExplanation": "Provider is not a Primary Care Physician.",
  "followupActionCode": "C"
}
]

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "51",    
  "rejectReasonDescription": "Provider Not on file",    
  "rejectReasonExplanation": "The provider is not recognized by the payer.",
  "followupActionCode": "C"
}
]

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "52",    
  "rejectReasonDescription": "Service Dates Not Within Provider Plan Enrollment",    
  "rejectReasonExplanation": "The requested service date is outside the provider's active 
   contract period with the payer.  Check eventDateBegin and eventDateEnd.",
  "followupActionCode": "C"
}
]

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "57",    
  "rejectReasonDescription": "Invalid/Missing Date(s) of Service",    
  "rejectReasonExplanation": "The eventDateBegin and/or eventDateEnd is missing or formatted incorrectly (e.g., MM/DD/YYYY instead of CCYYMMDD).",
  "followupActionCode": "C"
}
]

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "72",    
  "rejectReasonDescription": "Invalid/Missing Subscriber/Insured ID",    
  "rejectReasonExplanation": "The memberId is missing or does not match the payer's 
   records.",
  "followupActionCode": "C"
}
]

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "76",    
  "rejectReasonDescription": "Duplicate Subscriber/Insured ID Number",    
  "rejectReasonExplanation": "The payer's records contain more than one entry for memberId.  Include lastName and firstName and retry.",
  "followupActionCode": "C"
}
]

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.

"Validation": [
{
  "responseCode": "N",
  "rejectReasonCode": "T4",    
  "rejectReasonDescription": "Payer Name or Identifier Missing",    
  "rejectReasonExplanation": "The payerName value is empty or missing.",
  "followupActionCode": "C"
}
]

AAA Rejection codes are part of the Prior Authorization 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 Prior Authorization 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 Prior Authorization Inquiry exceeds the maximum allowed by the payer or information source. For example: If the inquiry asks for more service units or visits than permitted, the system flags this with AAA03 = 04. The payer is essentially saying: “Your request is valid, but the quantity you asked for is beyond what is authorized.”
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 Prior Authorization 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	Wait and try again later. The system may be temporarily unavailable or under maintenance.
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.
48	Invalid/Missing Referring Provider Identification Number	Referring provider's NPI is not registered with the payer plans. Provider must contact payer directly. Enrollment with Optum is incorrect, contact enrollment department.
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.
50	Provider Ineligible for Inquiries	Provider is not registered for that service type with the payer, provider should contact payer directly.
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	Check the Qualifier in the SV1 or similar segment. Match Qualifier to Code Set (e.g., CPT → CJ, HCPCS → HC). Review Payer Companion Guide for accepted qualifiers. Correct and Resubmit (most AAA errors require action code “C”).
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 in the future.
58	Invalid/Missing Date-of-Birth (DOB)	DOB is not included in the request. DOB is incorrect in the request.
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. Patient name is spelled differently in the payer database than the provider entered into the request.
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 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 the LS2120 segment.
79	Invalid Participant Identification	NPI in the request is not on file with the payer.
80	No Response received - Transaction Terminated	Payer processing issue. Transaction timed out. Payer sent invalid response.
95	Patient Not Eligible	Check the patient’s coverage dates and plan details in your system or via payer portal. Ensure the submitted member ID, date of birth, and service dates match the payer’s records. Please correct and resubmit. If the patient truly has no coverage, you may need to inform the provider or patient instead of resubmitting.
97	Invalid or Missing Provider Address	Ensure all required fields (street, city, state, ZIP) are present and correctly formatted. Confirm the address matches what the payer has on file for the provider’s NPI. Please correct and resubmit. [developer.optum.com]
98	Experimental Service or Procedure	Ensure the code is present and formatted correctly (e.g., ICD-10-CM or ICD-9-CM as required). Confirm the diagnosis code is valid for the requested service and supported by the payer. Please correct and resubmit.
AA	Authorization Number Not Found	Check if prior authorization is required for the requested service type or procedure. Ensure the provider is in-network and authorized for the requested service. If the error includes follow-up action “C” or “R,” update the request with proper authorization details and resubmit. [uhcprovider.com]
AE	Requires Primary Care Physician Authorization	Confirm if the member’s benefit plan requires PCP authorization for the requested service. Contact the member’s PCP to secure the necessary referral or authorization. Ensure the PCP details and authorization number are included in the request. Add the PCP authorization information to the transaction and resubmit.
AF	Invalid/Missing Diagnosis Code(s)	Ensure all required diagnosis codes are present and formatted correctly (ICD-10-CM or ICD-9-CM as required). Confirm the diagnosis codes are valid for the requested service and supported by the payer. Please correct and resubmit.
AG	Invalid/Missing Procedure Code(s)	Ensure all required procedure codes are present and formatted correctly (e.g., CPT, HCPCS, ICD procedure codes). Confirm the procedure codes are valid for the requested service and supported by the payer. Please correct and resubmit.
AI	Invalid/Missing Accident Date	If the service is related to an accident, ensure the accident date is provided in the correct format (YYYYMMDD) in the appropriate segment. Include the correct related cause code (e.g., employment, auto accident, other accident) along with the accident date. For claims, this often maps to HCFA Box 10 fields. [support.drchrono.com] Confirm the accident date aligns with the payer’s policy and is within allowable timeframes. Please correct and resubmit.
AM	Invalid/Missing Admission Date	Ensure the admission date is provided in the correct format and is required for the type of service (e.g., inpatient). Confirm the admission date aligns with the payer’s policy and allowable timeframes. Please correct and resubmit.
AN	Invalid/Missing Discharge Date	Ensure the discharge date is provided in the correct format and is required for the type of service. Confirm the discharge date aligns with the payer’s policy and allowable timeframes. Please correct and resubmit.
AO	Additional Patient Condition Information Required	Check the payer’s companion guide or policy for what additional patient condition details are needed (e.g., ICD-10 codes, severity indicators). Include all necessary diagnosis codes, condition indicators, and supporting clinical data in the request. Please correct and resubmit.
CI	Certification Information Does Not Match Patient	Confirm the certification or authorization number is correct and associated with the patient in question. Ensure the patient’s name, date of birth, and ID match the payer’s records for that certification. Update the request with accurate certification and patient details.
E8	Requires Medical Review	Include all required medical records, notes, and supporting documents that demonstrate medical necessity. Review the payer’s companion guide or policy for what documentation is needed for medical review. Some cases require direct communication with the payer’s utilization management team. If AAA04 indicates “C” or “R,” update the request with the required documentation and resubmit.
IA	Invalid Authorization Number Format	Review the payer’s companion guide for the correct authorization number format (length, character type). Ensure the number matches the payer-issued authorization exactly, without extra spaces or invalid characters. Please correct and resubmit.
IP	Inappropriate Provider Role	Ensure the correct provider role code is included in the request (e.g., referring provider for referrals, rendering provider for services). Review the payer’s companion guide for valid provider role codes and rules for the requested service. Please correct and resubmit.
MA	Missing Authorization Number	Confirm if the requested service requires an authorization number and where it should be placed in the transaction (usually in the REF segment). Include the correct authorization or certification number issued by the payer. Please correct and resubmit.
NC	No Certification Information Found	Confirm that the certification or authorization number is correct and associated with the patient and service. Ensure the payer has issued an authorization for the requested service. If not, initiate a new authorization request. Include accurate certification information or submit a new request if no prior authorization exists.
T4	Payer Name or Identifier Missing	Incorrect/invalid payer ID. Payer processing issue.
T5	Certification Information Missing	Review the payer’s companion guide for what certification information is mandatory (e.g., authorization number, certification dates). Include the correct certification or authorization number and any required supporting data in the appropriate segment. Please correct and resubmit.

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