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Back   Code Value Usage in Eligibility Benefit Inquiry and Subsequent Response (007030X347)

Purpose

For the health care industry to achieve the potential administrative cost savings with Electronic Data Interchange (EDI), standards have been developed and need to be implemented consistently by all organizations. To facilitate a smooth transition into the EDI environment, uniform implementation is critical.

The purpose of this Technical Report Type 2 is to provide explanation, and where necessary, identify requirements that must be supported when a conducting transaction set exchanges involving the Health Care Eligibility, Coverage, or Benefit Inquiry (270) and Health Care Eligibility, Coverage, or Benefit Information (271) transaction sets. While the Technical Report Type 3 was designed to give guidance on how they should be implemented in the health care industry. Specifically, this guide defines where data is put and when it is included for the 270/271 transaction sets for the purpose of conveying health care eligibility and benefit information. This paired transaction set is comprised of two transactions: the 270, which is used to request (inquire) information, and the 271, which is used to respond with coverage, eligibility, and benefit information. The official names for these transactions are:
  • ANSI ASC X12 - Eligibility, Coverage, or Benefit Inquiry (270)
  • ANSI ASC X12 - Eligibility, Coverage, or Benefit Information (271)
The following sections are referenced in the Eligibility and Benefit Inquiry and Response Transaction within the Front Matter and the transaction structure. The title of the section herein mirrors the title of the section in the TR3 for alignment and relative association.

Primary Trading Partners

Trading partners include:
  • Providers
  • Facilities
  • Payers
  • Information Receivers
  • Information Source
  • Clearinghouses
  • Vendors
  • Practice Management Vendors

Additional Information

Registered 1/27/2016
Transaction Set ID 270/271 Standard Version 007030
ASC X12 DM# 041316 Owning Group X12N/TGB/WG1