| | | | | | | | | | | |
| | _Ref_ | Id | _________Element Name__________ | Req | Type | Min/Max | | |
| | AAA01 | 1073 | Yes/No Condition or Response Code | M | ID | 1/1 | | |
| | | | Description: Code indicating a Yes or No condition or response |
| | | | | Code | Name_______________________________ |
| | | | | N | No |
| | | | | Y | Yes |
| | AAA03 | 901 | Reject Reason Code | O | ID | 2/2 | | |
| | | | Description: Code assigned by issuer to identify reason for rejection |
| | | | | Code | Name_______________________________ |
| | | | | 15 | Required application data missing |
| | | | | 52 | Service Dates Not Within Provider Plan Enrollment |
| | | | | 53 | Inquired Benefit Inconsistent with Provider Type |
| | | | | 54 | Inappropriate Product/Service ID Qualifier |
| | | | | 55 | Inappropriate Product/Service ID |
| | | | | 56 | Inappropriate Date |
| | | | | 57 | Invalid/Missing Date(s) of Service |
| | | | | 60 | Date of Birth Follows Date(s) of Service |
| | | | | 61 | Date of Death Precedes Date(s) of Service |
| | | | | 62 | Date of Service Not Within Allowable Inquiry Period |
| | | | | 63 | Date of Service in Future |
| | | | | 69 | Inconsistent with Patient's Age |
| | | | | 70 | Inconsistent with Patient's Gender |
| | AAA04 | 889 | Follow-up Action Code | O | ID | 1/1 | | |
| | | | Description: Code identifying follow-up actions allowed |
| | | | | Code | Name_______________________________ |
| | | | | C | Please Correct and Resubmit |
| | | | | N | Resubmission Not Allowed |
| | | | | R | Resubmission Allowed |
| | | | | 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 |
