EDI 271 Eligibility, Coverage or Benefit Information

What is EDI 271 Eligibility, Coverage or Benefit Information?

One of the EDI X12 transaction sets, EDI 271 is used to provide information regarding the healthcare policy’s eligibility, coverage, or benefits information relative to a subscriber seeking medical services. This transaction set is generally used by insurance providers and government agencies.

The data elements of an EDI 271 Eligibility, Coverage, or Benefit Information document are divided into different segments, which include:

• Name and contact details of the information receiver
• Name of the recipient of the inquiry
• Details of the insurance plan
• Details about the eligibility or benefit information requested

EDI X12 271 Eligibility, Coverage or Benefit Information Sample

The following example shows the different data elements and segments that are found within an EDI 271 transaction set[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 Eligibility, Coverage or Benefit Information

The specifications of an EDI 271 document are as follows:

EDI 271 falls under the category of the X12N Insurance transaction set and is used to convey policy information requested in an EDI 270 transaction document. Using the EDI 270 and EDI 271 transaction sets has allowed healthcare service providers to stay compliant with HIPAA standards.

Achieve EDI Compliance with Astera EDIConnect

Astera EDIConnect is an enterprise-grade EDI solution that simplifies the process of sending and receiving EDI messages. With a built-in EDI parser, validator, and transaction builder, Astera EDIConnect can handle transaction sets in X12 and EDIFACT formats. It also offers code-free mapping of data to EDI formats and workflow automation to streamline the EDI process.

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