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X12 - 271 - Eligibility, Coverage or Benefit Information
X12 - 271 - Eligibility, Coverage or Benefit Information
Skylar Nguyen avatar
Written by Skylar Nguyen
Updated this week

Product: X12 EDI

Transaction: 271


271 - Eligibility, Coverage or Benefit Information

FUNCTIONAL GROUP=HB

This X12 Transaction Set contains the format and establishes the data contents of the Eligibility, Coverage or Benefit Information Transaction Set (271) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to communicate information about or changes to eligibility, coverage or benefits from information sources (such as - insurers, sponsors, payors) to information receivers (such as - physicians, hospitals, repair facilities, third party administrators, governmental agencies). This information includes but is not limited to: benefit status, explanation of benefits, coverages, dependent coverage level, effective dates, amounts for co-insurance, co-pays, deductibles, exclusions and limitations.


SCHEMA


ST

Segment

Name

Position

ST

0100

BHT

Beginning of Hierarchical Transaction

0200

2000

Segment

Name

Position

HL

0100

TRN

Trace

0200

AAA

Request Validation

0250

2100

Segment

Name

Position

NM1

Individual or Organizational Name

0300

REF

0400

N2

0500

N3

0600

N4

0700

PER

0800

AAA

Request Validation

0850

PRV

Provider Information

0900

DMG

Demographic Information

1000

INS

Insured Benefit

1100

HI

Health Care Information Codes

1150

DTP

Date or Time or Period

1200

LUI

Language Use

1250

MPI

Military Personnel Information

1275

2110

Segment

Name

Position

EB

Eligibility or Benefit Information

1300

HSD

Health Care Services Delivery

1350

REF

1400

DTP

Date or Time or Period

1500

AAA

Request Validation

1600

VEH

Vehicle Information

1700

PID

1800

PDR

Property Description - Real

1900

PDP

Property Description - Personal

2000

LIN

2100

EM

Equipment Characteristics

2200

SD1

Safety Data

2300

PKD

Packaging Description

2400

MSG

Message Text

2500

2115

Segment

Name

Position

III

Information

2600

DTP

Date or Time or Period

2700

AMT

2800

PCT

Percent Amounts

2900

2117

Segment

Name

Position

LQ

Industry Code Identification

3000

AMT

3100

PCT

Percent Amounts

3200

LS

Loop Header

3300

2120

Segment

Name

Position

NM1

Individual or Organizational Name

3400

N2

3500

N3

3600

N4

3700

PER

3800

PRV

Provider Information

3900

LE

Loop Trailer

4000

SE

Transaction Set Trailer

4100


COMMENTS


Notes

2/0200

If the Eligibility, Coverage or Benefit Inquiry Transaction Set (270) includes a TRN segment, then the Eligibility, Coverage or Benefit Information Transaction Set (271) must return the trace number identified in the TRN segment.

rev 29/11/2024

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