For 278 Notifications and Acknowledgment & 278 Request for Review and Response, if a system does not support the type of review requested, does X12 offer guidance for how the system should respond?
Examples:
1) If the request/notification is valid technically and the receiving system can ingest the message, but requested dental services and the receiving system is not used for dental review, should we respond with an error? Or respond with a modified request?
2) If the request/notification sent fields for information copy that aren’t used or necessary in the source system, such as monetary limits that aren’t contractually needed, should we respond with an error? Or just omit those items on the reply?
Response for the Request/Response:
If the Request is submitted for a type of review not supported by the system, the AAA = 33 (Input Errors) error code should be used at either the event level or the service level. In addition, HCR01 = A3 (Not Certified) and HCR03 = 25 (Services were not considered due to other errors in the request) combination could be used along with a MSG segment to further clarify the reason for rejection, if needed at the event level when the AAA = 33 (Input Errors) is being sent at the service level.
Response for the Notification/Acknowledgment:
If the Notification is submitted for a type of review not supported by the system, the AAA = 33 (Input Errors) error code should be used at either the event level or the service level.