Section title: Requests for Interpretation
RFI #
1640
Attempt Lookup-LN and/or FN
Description

Would it be compliant/correct to return an AAA01 = Y when a match was not found on the LN or FN (AAA03=73/65) but data in the elements met the payer's requirements for format, datatype, length and existence? We believe an AAA01 = N would not be appropriate when no match is found because we believe an AAA01 = N must only be returned if value sent in NM103/NM104 (depending) required correcting by the provider per the payer's format, data type, length and/or existence requirements.

RFI Response

Yes it would be compliant/correct to return the AAA01 = Y when a match was not found on the LN or FN (AAA03=73/65) but data in the element met the payer's requirements for format, datatype, length and existence. 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).

DOCUMENT ID
005010X279