CAQH CORE 259: AAA Error Code Reporting Rule

CAQH CORE 259CAQH CORE 259: Operating 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, 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 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.

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.

CAQH CORE 259 Rule notes that the rule defines a standard way to report errors that prevent health plans (or information sources) from responding with the eligibility information for the requested patient or subscriber. The rule requires use of a unique error code, wherever possible, for a given error condition so that the re-use of the same error code is minimized. Where this is not possible, the goal (when re-using an error code) is to return a unique combination of one or more AAA segments along with one or more of the submitted patient identifying data elements such that the provider will be able to determine as precisely as possible what data elements are in error and take the appropriate corrective action. The CAQH CORE Rule does not require error condition descriptions to be returned.

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