271 Eligibility, Coverage or Benefit Information

Functional Group HB

X12N Insurance Subcommittee

This X12 Transaction Set contains the format and establishes the data contents of the Eligibility, Coverage or Benefit Information Transaction Set (271) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to communicate information about or changes to eligibility, coverage or benefits from information sources (such as - insurers, sponsors, payors) to information receivers (such as - physicians, hospitals, repair facilities, third party administrators, governmental agencies). This information includes but is not limited to: benefit status, explanation of benefits, coverages, dependent coverage level, effective dates, amounts for co-insurance, co-pays, deductibles, exclusions and limitations.

Heading

Position
Segment
Name
Max use
0100
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
0200
Beginning of Hierarchical TransactionMandatory
Max 1
To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time

Detail

Position
Segment
Name
Max use
2000 Loop
Repeat >1
0100
Hierarchical LevelMandatory
Max 1
To identify dependencies among and the content of hierarchically related groups of data segments
0200
TraceOptional
Max 9
To uniquely identify a transaction to an application
If the Eligibility, Coverage or Benefit Inquiry Transaction Set (270) includes a TRN segment, then the Eligibility, Coverage or Benefit Information Transaction Set (271) must return the trace number identified in the TRN segment.
0250
Request ValidationOptional
Max 9
To specify the validity of the request and indicate follow-up action authorized
2100 Loop
Repeat >1
0300
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
0400
Reference InformationOptional
Max 9
To specify identifying information
0600
Party LocationOptional
Max 1
To specify the location of the named party
0700
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
0800
Administrative Communications ContactOptional
Max 3
To identify a person or office to whom administrative communications should be directed
0850
Request ValidationOptional
Max 9
To specify the validity of the request and indicate follow-up action authorized
0900
Provider InformationOptional
Max 1
To specify the identifying characteristics of a provider
1000
Demographic InformationOptional
Max 1
To supply demographic information
1100
Insured BenefitOptional
Max 1
To provide benefit, characteristics, and identification information on insured entities.
1150
Health Care Information CodesOptional
Max 1
To supply information related to the delivery of health care
1200
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
1250
Language UseOptional
Max 9
To specify language, type of usage, and proficiency or fluency
2105 Loop
Repeat >1
1290
Transaction Set Line NumberMandatory
Max 1
To reference a line number in a transaction set
1295
Date/Time ReferenceOptional
Max >1
To specify pertinent dates and times
2110 Loop
Repeat >1
1300
Eligibility or Benefit InformationMandatory
Max 1
To supply eligibility or benefit information
1320
Specific Benefit InformationOptional
Max 20
To specify specifc benefit scenarios
1350
Health Care Services DeliveryOptional
Max 9
To specify the delivery pattern of health care services
1400
Reference InformationOptional
Max 9
To specify identifying information
1500
Date or Time or PeriodOptional
Max 20
To specify any or all of a date, a time, or a time period
1600
Request ValidationOptional
Max 9
To specify the validity of the request and indicate follow-up action authorized
1700
Vehicle InformationOptional
Max 1
To provide descriptions that identify a specific vehicle
1800
Product/Item DescriptionOptional
Max 1
To describe a product or process in coded or free-form format
1900
Property Description - RealOptional
Max 1
To provide a description of real property
2000
Property Description - PersonalOptional
Max 1
To provide a description of personal property
2100
Item IdentificationOptional
Max 1
To specify basic item identification data
2200
Equipment CharacteristicsOptional
Max 1
To send additional information regarding a specific piece of equipment
2300
Safety DataOptional
Max 1
To provide safety data information to recipients of the transaction, including identification of the hazard that the material being described represents, and the organization or party which declared this material to be a hazard or established exposure limits or other guidelines for that material
2400
Packaging DescriptionOptional
Max 1
To specify a package description and other information
2500
Message TextOptional
Max 10
To provide a free-form format that allows the transmission of text information
2550
Tooth IdentificationOptional
Max >1
To identify a tooth by number and, if applicable, one or more tooth surfaces
2115 Loop
Repeat >1
2700
Date or Time or PeriodOptional
Max 5
To specify any or all of a date, a time, or a time period
2800
Monetary Amount InformationOptional
Max 5
To indicate the total monetary amount
2900
Percent AmountsOptional
Max 5
To qualify percent amounts and supply percent amounts
2117 Loop
Repeat >1
3000
Industry Code IdentificationMandatory
Max 1
To identify standard industry codes
3100
Monetary Amount InformationOptional
Max 5
To indicate the total monetary amount
3200
Percent AmountsOptional
Max 5
To qualify percent amounts and supply percent amounts
3300
Loop HeaderOptional
Max 1
To indicate that the next segment begins a loop
2120 Loop
Repeat >1
3400
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
3600
Party LocationOptional
Max 1
To specify the location of the named party
3700
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
3800
Administrative Communications ContactOptional
Max 3
To identify a person or office to whom administrative communications should be directed
3900
Provider InformationOptional
Max 1
To specify the identifying characteristics of a provider
4000
Loop TrailerOptional
Max 1
To indicate that the loop immediately preceding this segment is complete
4100
Transaction Set TrailerMandatory
Max 1
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)

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