A recent national survey of providers found that 41 percent of organizations now face denial rates of 10 percent or higher, and missing or inaccurate data sits among the top reasons. You feel that in a very concrete way, every time a clean visit turns into extra staff work because eligibility was off by a little bit at the start. Buried inside those eligibility responses are two quiet signals, the AAA and EB codes, that often decide whether you get paid on the first try or on the third.
Eligibility sounds like a back office concern, yet it shapes who gets seen this week, how long staff spend on the phone, and how predictable your cash flow feels. When a payer responds to a 270 inquiry with a 271, it is not just confirming coverage in a general sense. It is sending structured information about the status of the request and the specifics of the member’s benefits.
AAA and EB codes sit at the core of that structure. AAA codes tell you whether the request itself is valid, and why it might have failed validation. EB codes tell you what coverage looks like for that member, including status, service types, limitations, and patient cost share, following patterns described in the current CAQH CORE Eligibility and Benefits 270 271 Data Content Rule.
When staff skip those signals, the consequences show up a few weeks later as preventable denials. A recent national survey of providers, for example, reported that 41 percent of organizations now live with denial rates of at least 10 percent of claims, and named missing or inaccurate data and incomplete registration among the leading causes, according to Experian Health. For high volume outpatient clinics, that is not trivia, it is the difference between a manageable work queue and constant rework.
This is also the territory where Solum Health operates. Solum positions itself as a unified inbox and AI intake automation layer for outpatient facilities, specialty ready and integrated with EHR and practice management systems, and it leans heavily on eligibility data to produce measurable time savings. When eligibility is captured and interpreted correctly at the front, the unified inbox and intake flows stay cleaner, and staff spend less time chasing fixes.
AAA and EB live inside the X12 270 and 271 standard, which defines how eligibility requests and responses move between providers and health plans. The provider system sends a 270 inquiry, the payer responds with a 271, and that 271 uses segments like AAA and EB to encode the result.
An AAA segment is essentially a validation verdict. It answers questions such as, did the plan understand this request, and can it respond, or is something structurally wrong with the inquiry.
In practice, AAA segments are used when the plan needs to report issues such as missing required data, invalid subscriber or member identifiers, date mismatches, or other format problems. If key fields in the 270 are incomplete or wrong, the 271 will often carry AAA codes that specify the error category and the suggested follow up. The CAQH CORE rules even call out AAA error code reporting as a distinct requirement, which underscores its importance.
For operations leaders, the key is that AAA is not background noise. It is a compact error report that can point your team to the exact place where a registration or intake workflow is introducing bad data. If your staff are often re keying information between your intake tools and payer portals, recurring AAA patterns are a signal that the handoff needs attention.
Where AAA is about validation, EB is about benefits. EB segments describe what is actually covered for the member, and on what terms. An EB segment can state whether coverage is active, list service type codes, indicate whether a benefit is limited, and specify elements of patient financial responsibility such as deductible, coinsurance, or copay.
A single 271 response may include many EB segments, because each one speaks to a particular slice of coverage. One segment might address general medical benefits, another might address behavioral health, and another might address a service category that matters to therapy practices. The CAQH CORE rule requires plans to return specific financial data in these segments, including base and remaining deductibles and information about whether authorization is required.
From a clinic perspective, EB is where you confirm whether a given visit type and setting fit within the benefit design, and what your staff should tell patients about their likely cost share. Ignoring EB means leaving that interpretation to luck or to a hurried call with the payer later in the day.
An AAA code is a validation segment in the 271 response that indicates whether the eligibility inquiry can be processed It reports issues such as missing required data, invalid subscriber identifiers, or other format problems, and it guides you on what needs correction before you try again.
An EB code is an eligibility and benefit segment that describes a specific part of the member’s coverage It can indicate whether coverage is active, which service categories are included, whether there are limits or conditions such as authorization, and what level of patient cost sharing applies.
It is normal to see multiple EB segments in a single 271 response Each EB segment describes one slice of coverage, for example general medical benefits, outpatient therapy, or mental health services, so reading them together gives you a fuller picture of how a plan will treat your planned visit.
AAA codes help you correct invalid or incomplete requests before they ever turn into claims, which reduces denials tied to registration errors. EB codes help you verify that a planned service fits within coverage, and that any limits or authorization requirements are addressed before the visit, which lowers the chance of avoidable denials afterward.
AAA and EB segments follow the X12 and CAQH CORE standards, so the basic structure and intent are consistent across payers. Individual plans may still vary in how much detail they include or which service types they emphasize, so it is worth learning the patterns for your top payers, but the underlying logic stays recognizable.
If you want to act on this quickly, start with three concrete moves:
Eligibility response codes will never be glamorous, but read in context, they give you early visibility into problems that would otherwise show up as denials, delays, and extra workload. That alone makes them worth a careful look this week, not sometime later when the queue is calmer.
