EDI 271 Eligibility, Coverage or Benefit Information
Functional Group HB
X12N Insurance Subcommittee
This X12 Transaction Set contains the format and establishes the data contents of the Eligibility, Coverage or Benefit Information Transaction Set (271) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to communicate information about or changes to eligibility, coverage or benefits from information sources (such as - insurers, sponsors, payors) to information receivers (such as - physicians, hospitals, repair facilities, third party administrators, governmental agencies). This information includes but is not limited to: benefit status, explanation of benefits, coverages, dependent coverage level, effective dates, amounts for co-insurance, co-pays, deductibles, exclusions and limitations.
Heading
- 0100Transaction Set HeaderMandatoryMax 1
To indicate the start of a transaction set and to assign a control number
- 0200Beginning of Hierarchical TransactionMandatoryMax 1
To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time
Detail
- 2000 Loop MandatoryRepeat >1
- 0100Hierarchical LevelMandatoryMax 1
To identify dependencies among and the content of hierarchically related groups of data segments
- 0200TraceOptionalMax 9
To uniquely identify a transaction to an application
If the Eligibility, Coverage or Benefit Inquiry Transaction Set (270) includes a TRN segment, then the Eligibility, Coverage or Benefit Information Transaction Set (271) must return the trace number identified in the TRN segment. - 0250Request ValidationOptionalMax 9
To specify the validity of the request and indicate follow-up action authorized
- 2100 Loop OptionalRepeat >1
- 0300Individual or Organizational NameMandatoryMax 1
To supply the full name of an individual or organizational entity
- 0400Reference IdentificationOptionalMax 9
To specify identifying information
- 0500Additional Name InformationOptionalMax 1
To specify additional names
- 0600Address InformationOptionalMax 1
To specify the location of the named party
- 0700Geographic LocationOptionalMax 1
To specify the geographic place of the named party
- 0800Administrative Communications ContactOptionalMax 3
To identify a person or office to whom administrative communications should be directed
- 0850Request ValidationOptionalMax 9
To specify the validity of the request and indicate follow-up action authorized
- 0900Provider InformationOptionalMax 1
To specify the identifying characteristics of a provider
- 1000Demographic InformationOptionalMax 1
To supply demographic information
- 1100Insured BenefitOptionalMax 1
To provide benefit information on insured entities
- 1200Date or Time or PeriodOptionalMax 9
To specify any or all of a date, a time, or a time period
- 1250Language UseOptionalMax 9
To specify language, type of usage, and proficiency or fluency
- 2110 Loop OptionalRepeat >1
- 1300Eligibility or Benefit InformationMandatoryMax 1
To supply eligibility or benefit information
- 1350Health Care Services DeliveryOptionalMax 9
To specify the delivery pattern of health care services
- 1400Reference IdentificationOptionalMax 9
To specify identifying information
- 1500Date or Time or PeriodOptionalMax 20
To specify any or all of a date, a time, or a time period
- 1600Request ValidationOptionalMax 9
To specify the validity of the request and indicate follow-up action authorized
- 1700Vehicle InformationOptionalMax 1
To provide descriptions that identify a specific vehicle
- 1800Product/Item DescriptionOptionalMax 1
To describe a product or process in coded or free-form format
- 1900Property Description - RealOptionalMax 1
To provide a description of real property
- 2000Property Description - PersonalOptionalMax 1
To provide a description of personal property
- 2100Item IdentificationOptionalMax 1
To specify basic item identification data
- 2200Equipment CharacteristicsOptionalMax 1
To send additional information regarding a specific piece of equipment
- 2300Safety DataOptionalMax 1
To provide safety data information to recipients of the transaction, including identification of the hazard that the material being described represents, and the organization or party which declared this material to be a hazard or established exposure limits or other guidelines for that material
- 2400Packaging DescriptionOptionalMax 1
To specify a package description and other information
- 2500Message TextOptionalMax 10
To provide a free-form format that allows the transmission of text information
- 2115 Loop OptionalRepeat >1
- 2600InformationMandatoryMax 1
To report information
- 2700Date or Time or PeriodOptionalMax 5
To specify any or all of a date, a time, or a time period
- 2800Monetary AmountOptionalMax 5
To indicate the total monetary amount
- 2900Percent AmountsOptionalMax 5
To qualify percent amounts and supply percent amounts
- 2117 Loop OptionalRepeat >1
- 3000Industry CodeMandatoryMax 1
Code to transmit standard industry codes
- 3100Monetary AmountOptionalMax 5
To indicate the total monetary amount
- 3200Percent AmountsOptionalMax 5
To qualify percent amounts and supply percent amounts
- 3000Industry CodeMandatoryMax 1
- 2600InformationMandatoryMax 1
- 3300Loop HeaderOptionalMax 1
To indicate that the next segment begins a loop
- 2120 Loop OptionalRepeat 1
- 3400Individual or Organizational NameMandatoryMax 1
To supply the full name of an individual or organizational entity
- 3500Additional Name InformationOptionalMax 1
To specify additional names
- 3600Address InformationOptionalMax 1
To specify the location of the named party
- 3700Geographic LocationOptionalMax 1
To specify the geographic place of the named party
- 3800Administrative Communications ContactOptionalMax 3
To identify a person or office to whom administrative communications should be directed
- 3900Provider InformationOptionalMax 1
To specify the identifying characteristics of a provider
- 3400Individual or Organizational NameMandatoryMax 1
- 4000Loop TrailerOptionalMax 1
To indicate that the loop immediately preceding this segment is complete
- 1300Eligibility or Benefit InformationMandatoryMax 1
- 0300Individual or Organizational NameMandatoryMax 1
- 0100Hierarchical LevelMandatoryMax 1
- 4100Transaction Set TrailerMandatoryMax 1
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)