Section title: Requests for Interpretation
RFI #
2359
2000A Loop AAA error
Description

Payer is returning a AAA03 of 42 in the 2000A loop due to a provider not being credentialed and on file with the payer. Please confirm if this is an inappropriate use of the AAA error in the 2000A loop.
Additional details:
AAA segment in the 2000A Loop:
Use of this segment at this location in the HL is to identify reasons why a request cannot be processed based on the entities identified in ISA06, ISA08, GS02 or GS03.

Further explanation per the X12 guide regarding a AAA03 of 42 states:
Use this code to indicate that the entity identified in either ISA08 or GS03 is unable to process the transaction at the current time. This indicates that there is a problem within the systems of the entity identified in either ISA08 or GS03 and is not related to any problem with the Information Source Identified in Loop 2100A.

Response

You are correct, returning 2000A AAA 42 for this situation is inappropriate. The correct way to return the 271 to identify a provider is not on file is through the 2100B AAA. The AAA03 value of “51” Provider Not On File should be returned.

DOCUMENT ID
005010X279