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EDI 270/271

The 270/271 healthcare transactions are EDI functions for
Eligibility and benefits inquiry and response.

EDI 270/271 Benefits Inquiry

EDI transaction to inquire about the healthcare eligibility and benefits

The 270/271 transactions, also known as Healthcare Eligibility Benefits Inquiry and Response is a paired transaction set that includes inquiry (270) and response (271). EDI transaction 270 is used to request information regarding health insurance eligibility and benefits associated with a dependent or subscriber from the insurance company. This inquiry can be for a single date or a date range. The 271 transaction is the EDI function to respond to a request made in transaction 270 to check eligibility status and coverage. Each plan under which the patient is covered provides details about various services included, the benefits associated, and financial information, such as deductibles, ID number, co-payment, date of coverage, commercial coordination of benefit (COB), exclusion, limitations, out of the pocket amount, etc.

All the details must be loaded to patients’ schedule and the aim is to receive services from service providers before care being rendered.

Edi-270-271

EDI 270/271 Benefits

EDI 270/271 eligibility inquiry and response is the electronic
verification that offers several benefits.

  • Increased efficiency and productivity
  • Faster reimbursement
  • Lower collected and billing costs
  • Better cash flow
  • Less rejected claims
  • Reduced manual and administrative tasks
  • Available for participating and non-participating healthcare professionals

EDI 270/271 Process Workflow

Get experts help in EDI 270/271 process workflow and avail benefits
Inquiry and response services as and when required.

Transaction Validation

  • A transaction that fails to comply is rejected
  • Compliant transactions generate a file to the sender
  • Each transaction is validated to ensure compliance
healthcare-medical EDI -837
Sending EDI 837 EDI

Transmission Administrative

  • Specific transmission administrative procedure
  • Partner determine if the transaction is using an appropriate indicator
  • The submitter is authorized through username and password

Re-Transmission

  • 271 AAA data segment provide information on whether a submission is allowed or not
  • What data corrections need to be made for a successful person
  • Partners must reconnect and initiate the file transfer process
Re-Transmission
Communication Protocol

Communication Protocol

Methods to get eligibility and benefits

  • Portal- Direct Data Entry (DDA)
  • Real-time- Value Added Network (VAN)
  • Portal- Batch

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Get desired services before care is rendered with EDI 270 / 271