EDI 271 Transaction Specifications and Formatting

Blog / EDI 271 Transaction Specifications and Formatting
When a specific subscriber or the subscriber's dependant needs medical treatment, the EDI 271 Health treatment Eligibility/Benefit Response transaction set is used to deliver information on healthcare policy coverages. In response to a 270 inquiry transaction, it is sent. Usually, organisations that would have knowledge of a particular policy would send this transaction, such as insurance firms, governmental organisations like Medicare or Medicaid, or other businesses. To find out if and to what degree a patient is insured for particular services, it is forwarded to healthcare service providers like hospitals or clinics. Typically, the 271 document contains the following:
  • Information about the inquiry's sender, including the information receiver's name and contact information
  • Name of the inquiry's target (the information source)
  • Information about the plan subscriber to which the question is related
  • Describe the eligibility or benefit information that has been requested.
The 270 and 271 transaction sets together make up the third-most common transactions in the healthcare industry. The usage of phone calls or faxes to seek and provide information on a patient's coverage under a plan was superseded by the adoption of these transactions. Service providers may send the same question to several insurance carriers and receive information in the same standardised 271 answer format by switching to the usage of EDI and these particular transactions. Healthcare service providers can also maintain HIPAA compliance by using the 270 and 271 transactions.
As of March 31, 2012, healthcare providers must adhere to the most recent HIPAA EDI requirements, version 5010. Healthcare organisations may manage their EDI initiatives with the help of 1 EDI Source's EDI Outsourcing services, which are simple and affordable. Let the professionals at 1 EDI Source handle all of your routine EDI duties while guaranteeing strict adherence to HIPAA regulations.

EDI 271 Specification

The Eligibility, Coverage or Benefit Information Transaction Set (271)'s structure and data contents are established in this X12 Transaction Set for usage in an electronic data interchange (EDI) environment. This transaction set can be used to transmit information from information sources (like insurers, sponsors, or payors) to information receivers (like doctors, hospitals, repair facilities, third party administrators, or governmental organisations) regarding eligibility, coverage, or benefit changes. These details include, but are not limited to: the benefit status, a description of the benefits, the coverages, the degree of dependent coverage, the effective dates, the co-insurance, co-pay, and deductible amounts, as well as exclusions and limits.

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