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Back   Health Care Eligibility/Benefit Inquiry and Information Response (005010X203)

Purpose

WITHDRAWN, SEE #279.

The Health Care Eligibility/Benefit Inquiry and Information Response Implementation Guide describes the use of the Eligibility, Coverage or Benefit Inquiry (270) Version/Release 005010 transaction set and the Eligibility, Coverage, or Benefit Information (271) Version/Release 005010 transaction set for the following business usages:
  • Determine if an Information Source organization, such as an insurance company, has a particular subscriber or dependent on file
  • Determine the details of health care eligibility and/or benefit information

Primary Trading Partners

Trading partners include:
  • Health care providers, such as hospitals and physicians.
  • Health care payers, such as insurance companies, HMOs, and PPOs
  • State and Federal programs, such as Medicare, Medicaid, and TRICARE (CHAMPUS).

Exceptions/Limitations

Intended for use for health care eligibility/benefits. Does not provide a history of benefit usage. Is not intended for property & casualty or workers' compensation usage.

References

  • Health Care Eligibility/Benefit Inquiry and Information Response (003070X023)
  • Health Care Eligibility/Benefit Inquiry and Information Response (004010X092)
  • Health Care Eligibility/Benefit Inquiry and Information Response (004050X138)
  • Health Care Eligibility/Benefit Inquiry and Information Response (004060X196)

Coordination

ASC X12N Workgroup:
  • ASC X12N Property & Casualty Task Group's Claim Work Group (TG1/WG2)
  • Workers' Compensation/Disability Work Group (TG1/WG3).

Additional Information

Registered 10/2/2003 Published 2/15/2007
Transaction Set ID 270/271 Standard Version 005010
ASC X12 DM# Owning Group X12N/TG2/WG1