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Transaction Set
in
X12 Release 004010

271 Eligibility, Coverage or Benefit Information

Functional Group HB

This Draft Standard for Trial Use 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

Sequence
Segment
Name
Max use
010
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
020
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

Sequence
Segment
Name
Max use
2000 Loop
Repeat >1
010
Hierarchical LevelMandatory
Max 1
To identify dependencies among and the content of hierarchically related groups of data segments
020
Trace
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.
025
Request Validation
Max 9
To specify the validity of the request and indicate follow-up action authorized
2100 Loop
Repeat >1
030
Individual or Organizational Name
Max 1
To supply the full name of an individual or organizational entity
040
Reference Identification
Max 9
To specify identifying information
050
Additional Name Information
Max 1
To specify additional names or those longer than 35 characters in length
060
Address Information
Max 1
To specify the location of the named party
070
Geographic Location
Max 1
To specify the geographic place of the named party
080
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be directed
085
Request Validation
Max 9
To specify the validity of the request and indicate follow-up action authorized
090
Provider Information
Max 1
To specify the identifying characteristics of a provider
100
Demographic Information
Max 1
To supply demographic information
110
Insured Benefit
Max 1
To provide benefit information on insured entities
120
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
2110 Loop
Repeat >1
130
Eligibility or Benefit Information
Max 1
To supply eligibility or benefit information
135
Health Care Services Delivery
Max 9
To specify the delivery pattern of health care services
140
Reference Identification
Max 9
To specify identifying information
150
Date or Time or Period
Max 20
To specify any or all of a date, a time, or a time period
160
Request Validation
Max 9
To specify the validity of the request and indicate follow-up action authorized
170
Vehicle Information
Max 1
To provide descriptions that identify a specific vehicle
180
Product/Item Description
Max 1
To describe a product or process in coded or free-form format
190
Property Description - Real
Max 1
To provide a description of real property
200
Property Description - Personal
Max 1
To provide a description of personal property
210
Item Identification
Max 1
To specify basic item identification data
220
Equipment Characteristics
Max 1
To send additional information regarding a specific piece of equipment
230
Safety Data
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
240
Packaging Description
Max 1
To specify a package description and other information
250
Message Text
Max 10
To provide a free-form format that allows the transmission of text information
2115 Loop
Repeat >1
260
Information
Max 1
To report information
270
Date or Time or Period
Max 5
To specify any or all of a date, a time, or a time period
280
Monetary Amount
Max 5
To indicate the total monetary amount
290
Percent Amounts
Max 5
To qualify percent amounts and supply percent amounts
2117 Loop
Repeat >1
300
Industry Code
Max 1
Code to transmit standard industry codes
310
Monetary Amount
Max 5
To indicate the total monetary amount
320
Percent Amounts
Max 5
To qualify percent amounts and supply percent amounts
330
Loop Header
Max 1
To indicate that the next segment begins a loop
2120 Loop
Repeat 1
340
Individual or Organizational Name
Max 1
To supply the full name of an individual or organizational entity
350
Additional Name Information
Max 1
To specify additional names or those longer than 35 characters in length
360
Address Information
Max 1
To specify the location of the named party
370
Geographic Location
Max 1
To specify the geographic place of the named party
380
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be directed
390
Provider Information
Max 1
To specify the identifying characteristics of a provider
400
Loop Trailer
Max 1
To indicate that the loop immediately preceding this segment is complete
410
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)
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.