CAQH CORE 259: AAA Error Code Reporting Rule (Eligibility & Claim Status Operating Rules)

CAQH CORE 259: AAA Error Code Reporting Rule requires a health plan/information source to return a AAA segment for each error condition that it detects in a X12 270 request, as described in sections 4.3-4.5 of the rule. CAQH CORE 259: AAA Error Code Reporting Rule states that the receiver of the X12 271 response, i.e., the system that originated the X12 270 inquiry, is required to detect all combinations of error conditions from the AAA segments in the X12 271 responses, as defined in Table 4.5-1 Error Reporting Codes & Requirements, and to display to the receiving system’s end user text that uniquely describes the specific error condition(s) and data elements returned by the health plan in the X12 271 response.

CAQH CORE 259: AAA Error Code Reporting Rule Version 2.1.0 identifies 17 error conditions, some of which may occur in the subscriber loop and others which may occur in the dependent loop. Section 4.4 of the CAQH CORE 259 Rule states that “when a health plan detects any of the specified error conditions it must return an appropriate AAA segment for each error detected and return other data elements as specified.” Thus, the health plan would determine the loop in which to return the appropriate AAA error codes required by the CAQH CORE Rule.

CAQH CORE Rule does not require a health plan (or information source) to validate a DOB; however, when a DOB is validated and errors are found, the receiver of the X12 270 inquiry is required to return an X12 271 response as specified in the rule. The rule specifically identifies the AAA03 error codes that must be returned for each error condition, which may occur in either or both of the Subscriber or Dependent loops (refer to Rule Section 4.5 and the Error Reporting Codes & Requirements Table).

Due to the variability in search and match logic and the data elements used by health plans and information sources, some health plans and information sources may actually match the member in the X12 270 Inquiry test case rather than return the expected AAA error code in the X12 271 Response. An entity seeking CORE Certification can successfully pass the test for this rule by generating at least one X12 271 Response with an AAA Error Code for at least one of the certification test scripts.

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