3. How does a health plan identify the correct error condition description to return when multiple error conditions are mapped to the same code?

The CAQH CORE Eligibility & Benefits (270/271) Data Content Rule AAA Error Code Reporting requirement, §3.2.1, What the Rule Applies To, notes that the rule defines a standard way to report errors that prevent health plans (or information sources) from responding with the eligibility information for the requested patient or subscriber. The rule requires use of a unique error code, wherever possible, for a given error condition so that the re-use of the same error code is minimized.

4. Is a health plan or information source required to return an X12 271 Response with the specified AAA error codes for each test script for the CAQH CORE Eligibility & Benefits (270/271) Data Content Rule AAA Error Code Reporting requirement specified i

No. Due to the variability in search and match logic and the data elements used by health plans and information sources, some health plans and information sources may match the member in the X12 270 Inquiry test case rather than return the expected AAA error code in the X12 271 Response. An entity seeking CORE Certification can successfully pass the test for this rule by generating at least one X12 271 Response with an AAA Error Code for at least one of the Certification test scripts.

5. Does the CAQH CORE Eligibility & Benefits (270/271) Data Content Rule AAA Error Code Reporting requirement require that entities use specific AAA03 error codes for specific errors?

Yes. The rule specifically identifies the AAA03 error codes that must be returned for each error condition, which may occur in either or both of the Subscriber or Dependent loops (refer to Rule §3.3 and the Error Reporting Codes & Requirements Table 3.3.5 of the CAQH CORE Eligibility & Benefits (270/271) Data Content Rule AAA Error Code Reporting requirement).

6. Does the CAQH CORE Eligibility & Benefits (270/271) Data Content Rule AAA Error Code Reporting requirement require a health plan to validate date of birth?

No. This rule does not require a health plan (or information source) to validate a date of birth; however, when a date of birth is validated and errors are found, the receiver of the X12 270 Inquiry is required to return an X12 271 Response as specified in the rule.

7. When a health plan’s search criteria detects errors during its subscriber/dependent verification editing process, does the CAQH CORE Eligibility & Benefits (270/271) Data Content Rule AAA Error Code Reporting requirement specify in what loop (subscrib

The CAQH CORE Eligibility & Benefits (270/271) Data Content Rule AAA Error Code Reporting requirement identifies 17 error conditions, some of which may occur in the subscriber loop and others which may occur in the dependent loop.

9. Can a health plan/information source return a AAA error segment that contains only the first error condition detected or must it return as many AAA segments as there are errors in the X12 270?

A health plan/information source is required to return a AAA segment for each error condition that it detects in a X12 270 Inquiry, as described in §3.3 of the CAQH CORE Eligibility & Benefits (270/271) Data Content Rule AAA Error Code Reporting requirement.

10. In reviewing the CAQH CORE Eligibility & Benefits (270/271) Data Content Rule, I could not find any statement on how hyphenated or apostrophized last names should be handled, e.g., O'Donnell-Griswold? Should it be just Odonnell? Or is this addressed i

The CAQH CORE Eligibility & Benefits (270/271) Data Content Rule Last Name Normalization requirement  requires the removal of both the apostrophe and the hyphen in the O’Donnell-Griswold example cited. The normalized name would be ODONNELLGRISWOLD. §2.2.7 lists the X12-designated “special characters” of the “Basic Character Set” and the list includes both the apostrophe and the hyphen. §2.3.2.3. of the rule then says, “remove the special characters specified in §2.3.2 in the name element.”

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