Product: X12 EDI
Transaction: 271
Article Link: http://help.truecommerce.com/en/articles/10220855-x12-271-eligibility-coverage-or-benefit-information
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