EDI Resource Center

X12 EDI 271

What is an EDI 271 Eligibility, Coverage or Benefit Information?

The EDI 271 Eligibility, Coverage, or Benefit Information provides information from health insurers about healthcare policy coverages related to a specific subscriber or the subscriber's dependent seeking medical services.

How is EDI 271 Used?

This transaction is typically sent by insurance companies, government agencies, to healthcare service providers (hospitals or medical clinics) as a response to a 270 inquiry transaction.

The EDI 271 is used to inform healthcare providers (physicians, hospitals, repair facilities, governmental agencies) about eligibility, coverage or benefits from information sources (insurers, sponsors, payors).

EDI 271 Benefits

The 270 and 271 transaction sets represent the third-most used transactions in healthcare.

They come with several benefits:

  • Replacement in the use of phone or fax for requesting & giving information on a patient's coverage under a plan.
  • Same inquiry submissions to multiple insurance providers and the same standardized 271 response format received.
  • Healthcare service providers remain in compliance with HIPAA standards.

Key Data Elements You'll Find in an Eligibility, Coverage or Benefit Information:

  • Inquiry recipient name (information source)
  • Inquiry sender details (name & contact information of the information receiver)
  • Benefit information or description of eligibility requested
  • Details of the plan subscriber to whom the inquiry is referring

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