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.
