Section title: Requests for Interpretation
RFI #
1644
Attempt Lookup- MID/LN/FN Mult
Description

Would it be compliant/correct to return an AAA01 = Y when multiple matches were found on the MID and the LN (AAA03=73), but the FN happened to not match, and the data in the elements met the payer's requirements for format, data type, length and existence? We believe an AAA01 = N would not be appropriate when mutliple matches are found because we believe an AAA01 = N must only be returned if value sent in NM103, NM104 and/or NM109 required correcting by the provider per the payer's format, data type, length and/or existence requirements. Further, because multiple matches were made on the MID, wouldn't it be required to return AAA03=76 (Duplicate Subscriber/Insured ID)?

RFI Response

Yes it would be compliant/correct to return the AAA01 = Y when multiple matches were found on the MID and the LN (AAA03=73). It would not be compliant to return an AAA01=N when the data exists, and meets the payer's specifications. An AAA01=N should only be returned when the payer's specifications have not been met (invalid) or the data does not exist but is expected (missing).

Further, the AAA03 = 76 must be returned, when multiple matches were made on the ID.


DOCUMENT ID
005010X279