HIPAA 5010 271 Generic Response

Blog / HIPAA 5010 271 Generic Response
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 sender's name and the information receiver's contact information
  • Name of the inquirer's (the information source's) recipient
  • Information about the plan member to whom the query is referring
  • Information about eligibility or benefits described in the request
The two transaction sets together, 270 and 271, are the third-most common transactions in the healthcare industry. The use of these transactions has eliminated the need for calling or sending faxes to get information about a patient's insurance coverage requests and deliveries.

X12 HIPAA 271 Sample File

ISA*00* *00* *ZZ*1234567 *ZZ*11111 *170508*1141*>*00501*000000101*1*P*:~

GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X279A1~

ST*271*4321*005010X279A1~

BHT*0022*11*10001234*20060501*1319~

HL*1**20*1~

NM1*PR*2*ABC COMPANY*****PI*842610001~

HL*2*1*21*1~

NM1*1P*2*BONE AND JOINT CLINIC*****SV*2000035~

HL*3*2*22*0~

TRN*2*93175-012547*9877281234~

NM1*IL*1*SMITH*JOHN****MI*123456789~

N3*15197 BROADWAY AVENUE*APT 215~

N4*KANSAS CITY*MO*64108~

DMG*D8*19630519*M~

DTP*346*D8*20060101~

EB*1**30**GOLD 123 PLAN~

EB*L~

EB*1**1>33>35>47>86>88>98>AL>MH>UC~

EB*B**1>33>35>47>86>88>98>AL>MH>UC*HM*GOLD 123 PLAN*27*10*****Y~

EB*B**1>33>35>47>86>88>98>AL>MH>UC*HM*GOLD 123 PLAN*27*30*****N~

LS*2120~

NM1*P3*1*JONES*MARCUS****SV*0202034~

LE*2120~

SE*22*4321~

GE*1*101~

IEA*1*000000101~

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