EDI-271

What does Eligibility, Coverage or Benefit Information (EDI 271) mean?

Information from health insurers on healthcare insurance coverages pertaining to a specific subscriber or the subscriber’s dependant seeking medical services is provided in the EDI 271 Eligibility, Coverage, or Benefit Information.

EDI 271: How is it Used?

As a response to a 270 inquiry transaction, insurance companies and governmental organisations frequently send this transaction to healthcare service providers (hospitals or clinics).

The EDI 271 is used to communicate eligibility, coverage, or benefits from information sources (insurers, sponsors, payors) to healthcare providers (doctors, hospitals, repair facilities, government organisations).

EDI 271 Advantages

The third-most often utilised transaction sets in the healthcare industry are 270 and 271.
They provide a number of advantages:

• Replacement for calling or sending faxes to get information on a patient’s insurance coverage.
• The identical inquiry submissions were sent to other insurance companies, and they all received the same same 271 answer format.
• Healthcare service providers continue to adhere to HIPAA regulations.

Important Information Included in Eligibility, Coverage, or Benefit Information

• Name of the inquiry’s inquirer (information source)
• Information about the inquiry’s sender (including the recipient’s name and contact information)
• Requested: Benefit details or eligibility explanation
• Information about the plan subscriber to whom the question is directed