AAA03 — Reject Reason Code (X12 element 901)
95 — Patient Not Eligible
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (X12 005010X217 TR3 / element 901 code list — verify against licensed copy). Do not rely on it for production configuration until this notice is removed.
How 95 is used
Returned in AAA03. Coverage terminations and benefit carve-outs (services managed by another entity) are common causes; the carve-out case means the request should be routed elsewhere, not abandoned.
Example
A behavioral health request sent to the medical UMO when BH is carved out to another organization returns AAA03 = 95.
Where it lives in the transaction
95 is a value of AAA03 — Reject Reason Code (X12 element 901), carried in the AAA (Request Validation), 278 response — returned at the loop level where the problem was found of the 278 Health Care Services Review — Response (005010X217). For the payer-side view of how PA Bridge normalizes these codes across X12 and FHIR intake, see the articles section.