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Back   Health Care Eligibility/Benefit Inquiry and Information Response (004050X138)

Purpose

The Health Care Eligibility/Benefit Inquiry and Information Response Implementation Guide describes the use of the Eligibility, Coverage or Benefit Inquiry (270) Version/Release 3070 transaction set and the Eligibility, Coverage, or Benefit Information (271) Version/Release 3070 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

Health care providers, such as hospitals and physicians. Health care payers, such as insurance companies, HMOs, PPOs, and state and federal agencies, such as Medicare, Medicaid, and 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)

Coordination

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

Additional Information

Registered 1/12/2000
Transaction Set ID 270/271 Standard Version 004050
ASC X12 DM# Owning Group X12N/TG2/WG1