Section title: Requests for Interpretation
RFI #
1642
Attempt Lookup-LN/FN Mult Hit
Description

Would it be compliant/correct to return an AAA01 = Y when multiple matches were found on the MID (AAA03=76), and the 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 mutliple matches are found because we believe an AAA01 = N must only be returned if value sent in NM109 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 multiple matches were found on the MID (AAA03=76) 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