EDI 271-A1 Eligibility, Coverage or Benefit Information

What is EDI 271-A1 Eligibility, Coverage or Benefit Information?

An EDI 271-A1 document is used to convey information related to healthcare eligibility and benefits associated with a subscriber. The information exchanged includes data elements, such as the name and contact details of the information receiver, name of the recipient of the inquiry, explanation of benefits, and effective dates.

EDI X12 271-A1 Eligibility, Coverage or Benefit Information Sample

An EDI 271-A1 document is divided into functional groups that explain the contents of the transaction being conducted. A typical EDI 270-A1 document looks like this[1]:

ST*271*00001~
BHT*0022*11**20020202*0800*~
HL*1**20*1~
NM1*P5*2*CHILDREN’S SPECIAL HEALTH CARE*****FI*356000158**~
PER*IC*CHILDREN’S SPECIAL HEALTH CARE*TE*8004751355*TE*3172331351~
HL*2*1*21*1~
NM1*1P*2*Mayberry******SV*123456**~
AAA*N**51*C~ (Only if a 270 receiver error occurred)
HL*3*2*22*0~
TRN*2*98765-12345*9876543210*~
NM1*IL*1*Doe*Jane*A***MI*123456**~
REF*SY*123456789**~
N3*1234 Meridian*Apt 1E~
N4*Indianapolis*IN*46205***~
AAA*N**71*C~ (Only if a 270 subscriber error occurred)
DMG*D8*19500204*******~
DTP*307*RD8*20021201-20021231~
EB*1*IND*30**********~
REF*IG*123456789**~
SE*20*00001~

Workflow for the Exchange of EDI 271-A1 Eligibility, Coverage or Benefit Information

An EDI 271-A1 is used as an electronic response to the EDI 270 Eligibility, Coverage or Benefit Inquiry transaction set. The EDI 270 and 271-A1 transaction sets are often used together in the healthcare data exchange, and help healthcare service providers stay in compliance with HIPAA standards.

Achieve EDI Compliance with Astera EDIConnect

Astera EDIConnect is an EDI solution designed to handle EDI X12 and EDIFACT transaction sets. With a built-in message parser, validator, and transaction builder, Astera EDIConnect simplifies the process of sending and receiving EDI messages.

[1] https://www.in.gov/isdh/files/ISDH_Companion_Guide_270-271V1_2.pdf