Provider Notification
Clarification on Common Demographic Rejections
Date of Notification: July 25, 2014
Plans Affected: Mercy Maricopa Integrated Care
Revision Date: N/A
Mercy Maricopa has identified the following demographic reject reasons as “high-volume” and
offers the following suggestions to eliminate these errors. Errors are listed in rank order of most
common occurrences.
Error Description
Invalid Agency AHCCCS Id (Field #34).
The most common reason for this error was a missing ID. Other errors were a result of invalid
data. The expected value for this field is 6 numeric characters (agency AHCCCS ID) followed by 3
spaces. Errors included the use of alpha characters, and numeric values greater than 6-digits.
Some values were as long as a 9-digit numeric and appeared to be a Tax ID number (TIN).
Referral source is invalid (Field #23)
The most common reason for this error was due to the referral source value submitted on a
type 2 or 4 transaction not matching the referral source value reported on the type 1
transaction. This error also occurred when the Referral Source was reported on a type 3
transaction (this field is not reported on a type 3 transaction). The Referral Source reported on
type 2 & 4 transactions must match the Referral Source reported on the type 1 transaction for
the EoC.
If Primary Substance Abuse code indicates no substance abuse, frequency of use must also indicate no
usage (Fields #71-72).
The most common reason for this error was the use of value '7' (no use during the past 6
months) in the Primary SA Frequency field, following a Primary Substance type of '0001' (None).
The expected value is '1' (no use during the past month).
If Axis III-1 = 00, then all Axis III codes must = 00 (Fields # 52-56).
The Axis-III.1 thru III.5 codes are evaluated in a block. All errors occurred as a result of values
not meeting the pattern criteria, such as a medical condition code, '20' entered in Axis-III.2, and
'00' was entered in Axis-III.1. If valid medical conditions exist, these codes must be entered
prior to entering ’00.’ Once '00' is entered in one of the Axis-III positions, all remaining Axis-III
positions must be populated as '00'.
Invalid Delay Code Value (Field #25).
The most common reason for this error was the use of an invalid value such as '00.' Many EMRs
may be submitting '00' as a default value; however this is an invalid value for MMIC. The only
valid values are '01' thru '08', and spaces. There are no other validation checks on this field. If a
delay code is NOT being reported, use spaces in this field.
www.mercymaricopa.org
AZR-14-04-16
1
Invalid Improve Family Stress Value (Field #97).
Invalid Parent Child Interaction Value (Field #96).
Invalid Acceptable Emotional Regulation Value (Field #93).
Invalid Ready to Learn Value (Field #94).
Invalid Explore and Adapt Value (Field #95).
These fields are considered optional. Please insert the appropriate number of spaces if your
organization chooses to not utilize these fields.
The most common reason for these errors was for an invalid value such as 'O'. Many agency
EMRs may be submitting 'O' as a default value, however this is an invalid value for MMIC. Valid
values are 'Y', 'N', or 'X'. If any other values are encountered, an error will be generated.
• 'X' must be selected when client is age 5+.
• 'Y' or 'N' must be selected when client is age 0-4
Secondary Substance Abuse Age of First Use code is invalid (Field #78).
The most common reason for this error was due to the reported age exceeding the recipients
calculated age – the age of first use cannot be greater than the current age of the recipient.
Additionally, some errors occurred when an age was reported but no substance use was
reported. '00' must be used if no substance is reported in the corresponding substance type
field.
Secondary Substance Abuse Frequency code is invalid (Fields #75-76).
This is similar to the Primary Substance fields noted earlier. The most common reason for this
error was the use of value '7' (no use during the past 6 months) in the Secondary Frequency
field, following a Secondary Substance type of '0001' (None). The expected value is '1' (no use
during the past month).
Invalid Lives with Family value (Field #86).
Invalid Decreased safety Risk (Field # 88).
Invalid Increased Stability (Field #87).
These fields are considered optional. Please insert the appropriate number of spaces if your
organization chooses to not utilize these fields.
The common reason for these errors was for an invalid value such as 'O'. Many agency EMRs
may be submitting 'O' as a default value, however this is an invalid value for MMIC. Valid values
are 'Y', 'N', or 'X'. If any other values are encountered, an error will be generated.
• 'X' must be selected when client is age 0-4 or 18+.
• 'Y' or 'N' must be selected when client is age 5-17.
www.mercymaricopa.org
AZR-14-04-16
2