Registry



Back   Health Care Eligibility/Benefit Inquiry and Information Response (007030X332)

Purpose

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

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

Coordination

  • Property & Casualty Task Group's Claim Work Group
  • Workers' Compensation/Disability Work Group

Additional Information

Registered 9/8/2015
Transaction Set ID 270/271 Standard Version 007030
ASC X12 DM# Owning Group X12N/TGB