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Back   Health Care Eligibility/Benefit Inquiry and Information Response (006020X280)

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 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)
    • Health Care Eligibility/Benefit Inquiry and Information Response (005010X203)
    • Health Care Eligibility/Benefit Inquiry and Information Response (005010X279)

    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 6/6/2007
    Transaction Set ID 270/271 Standard Version 006020
    ASC X12 DM# Owning Group X12N/TG2/WG1