Why lossless AAA errors matter for eligibility checks

When an eligibility check fails, the reason matters. Incorrect patient data, a missing enrollment, or a payer outage each require a different fix from a different person.

Eligibility checks that are rejected by the payer comes back with an AAA error with the reason for the error and a recommended follow-up action. But many clearinghouses don't return AAA errors for eligibility responses. Or, in an effort to be helpful, they rewrite them into generic error messages.

Stedi returns lossless eligibility responses. Whatever the payer sends back, including AAA errors, we pass on to you. Nothing is left out or changed. For AAA errors, we also add resolution tips that outline the likely cause of the error and steps for fixing it.

What are eligibility checks?

An eligibility check is a standard healthcare transaction that confirms that a patient has active insurance and returns their plan benefits. You can run eligibility checks using Stedi’s JSON Eligibility API, X12 API, SOAP API, or the Stedi portal.

HIPAA requires eligibility checks to be exchanged in the X12 EDI format. If you use Stedi’s JSON API or the Stedi portal, we handle the translation to X12 for you.

What are AAA errors?

When a payer can't process an eligibility check or find a patient's coverage, it returns an error in the AAA segment (or section) of the X12 eligibility response. In the industry, these are called AAA errors.

Every AAA error includes three pieces of information:

• Code – What went wrong, such as a bad member ID or invalid name.

• Followup Action – What the payer recommends you do next.

• Location – Loop (or section) of the original X12 response that contains the error.

This is how an AAA error looks in Stedi’s Eligibility API responses:

{
  "errors": [
    {
      "code": "42",
      "description": "Unable to Respond at Current Time", // Derived from the code
      "followupAction": "Resubmission Allowed",
      "location": "Loop 2100A",
      "possibleResolutions": "This is typically a temporary issue with the payer's system, such as downtime. We recommend retrying immediately and continuing to retry for up to 2 minutes."
    }
  ],
  "status": "ERROR"
}

{
  "errors": [
    {
      "code": "42",
      "description": "Unable to Respond at Current Time", // Derived from the code
      "followupAction": "Resubmission Allowed",
      "location": "Loop 2100A",
      "possibleResolutions": "This is typically a temporary issue with the payer's system, such as downtime. We recommend retrying immediately and continuing to retry for up to 2 minutes."
    }
  ],
  "status": "ERROR"
}

{
  "errors": [
    {
      "code": "42",
      "description": "Unable to Respond at Current Time", // Derived from the code
      "followupAction": "Resubmission Allowed",
      "location": "Loop 2100A",
      "possibleResolutions": "This is typically a temporary issue with the payer's system, such as downtime. We recommend retrying immediately and continuing to retry for up to 2 minutes."
    }
  ],
  "status": "ERROR"
}

{
  "errors": [
    {
      "code": "42",
      "description": "Unable to Respond at Current Time", // Derived from the code
      "followupAction": "Resubmission Allowed",
      "location": "Loop 2100A",
      "possibleResolutions": "This is typically a temporary issue with the payer's system, such as downtime. We recommend retrying immediately and continuing to retry for up to 2 minutes."
    }
  ],
  "status": "ERROR"
}

{
  "errors": [
    {
      "code": "42",
      "description": "Unable to Respond at Current Time", // Derived from the code
      "followupAction": "Resubmission Allowed",
      "location": "Loop 2100A",
      "possibleResolutions": "This is typically a temporary issue with the payer's system, such as downtime. We recommend retrying immediately and continuing to retry for up to 2 minutes."
    }
  ],
  "status": "ERROR"
}

Everything except the resolution tip in the possibleResolutions field comes straight from the payer's AAA error response. Stedi adds the resolution tip based on the error code. Our eligibility troubleshooting docs also list resolution tips for common AAA error codes, including possible causes and next steps.

Who owns the fix?

Eligibility checks pass through several parties on their way to the payer and back:

If a check fails, one of these parties owns the fix. AAA errors help you determine which one: the submitter (on behalf of the provider), the payer, or Stedi.

When your clearinghouse drops or changes these AAA errors, troubleshooting is difficult, sometimes impossible. We've talked to several customers whose previous clearinghouse left them calling payers to ask why a check failed – an answer the payer had already sent in their original eligibility response. That's the primary reason Stedi returns lossless AAA errors.

Example: Incorrect patient information

If a payer can't match the patient information in an eligibility check to its system records, the payer typically returns AAA error 75 (Subscriber/Insured Not Found). In these cases, the submitter owns the fix. The submitter should:

1. Check that the patient information in the check is correct

2. Remove any unneeded patient information, such as address

3. Resubmit the check

Example: Payer outage

AAA error 42 (Unable to Respond at Current Time) and AAA error 80 (No Response received - Transaction Terminated) indicate a payer outage. There’s nothing necessarily wrong with the request; the payer’s system is down.

Where possible, Stedi maintains redundant routes to each payer with automatic failover, so many outages never reach you. When the payer itself is down, no clearinghouse can get through. In these cases, retrying the eligibility check is the most important next step.

Most payer outages last less than 30 minutes. If you need results now, retry immediately and keep retrying for as long as your workflow allows. If you can wait, retry after 1 minute, then double the interval between attempts, up to 30 minutes. Most retries return within 3-5 seconds.

Stedi doesn't bill for checks that return AAA error 42 or 80, so retrying costs nothing. For more retry tips, see our retry strategy docs.

More tips for resolving AAA errors

• Look for patterns: The Stedi portal’s Eligibility check errors page groups recent AAA errors by code and payer. If you’re seeing a spike in AAA errors for a particular payer or provider, it’s a good place to start troubleshooting.

• Retry with the Stedi Agent: The Stedi Agent is the Stedi portal’s built-in AI assistant. You can use the agent to resolve common recoverable eligibility check errors automatically.

• Build logic to prevent and recover failed checks: Our eligibility troubleshooting docs include tips for preventing and recovering from common AAA errors. Use a coding agent to review the docs and build that logic directly into your application.

Run eligibility checks with Stedi

You can try out Stedi’s eligibility checks for free with a sandbox account. The sandbox gives you access to mock eligibility requests for building test integrations.

You can upgrade to production whenever you're ready. There are no monthly minimums or setup fees. You only pay for the transactions you use.

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