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Transaction Set
in
X12 Release 008010

271 Eligibility, Coverage or Benefit Information

Functional Group HB

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

Sequence
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

Sequence
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
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.
0250
Request Validation
Max 9
To specify the validity of the request and indicate follow-up action authorized
2100 Loop
Repeat >1
0300
Individual or Organizational Name
Max 1
To supply the full name of an individual or organizational entity
0400
Reference Information
Max 9
To specify identifying information
0500
Additional Name Information
Max 1
To specify additional names
0600
Party Location
Max 1
To specify the location of the named party
0700
Geographic Location
Max 1
To specify the geographic place of the named party
0800
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be directed
0850
Request Validation
Max 9
To specify the validity of the request and indicate follow-up action authorized
0900
Provider Information
Max 1
To specify the identifying characteristics of a provider
1000
Demographic Information
Max 1
To supply demographic information
1100
Insured Benefit
Max 1
To provide benefit, characteristics, and identification information on insured entities.
1150
Health Care Information Codes
Max 1
To supply information related to the delivery of health care
1200
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
1250
Language Use
Max 9
To specify language, type of usage, and proficiency or fluency
1275
Military Personnel Information
Max 9
To report military service data
2105 Loop
Repeat >1
1290
Transaction Set Line Number
Max 1
To reference a line number in a transaction set
1295
Date/Time Reference
Max >1
To specify pertinent dates and times
2110 Loop
Repeat >1
1300
Eligibility or Benefit Information
Max 1
To supply eligibility or benefit information
1320
Specific Benefit Information
Max 20
To specify specifc benefit scenarios
1350
Health Care Services Delivery
Max 9
To specify the delivery pattern of health care services
1400
Reference Information
Max 9
To specify identifying information
1500
Date or Time or Period
Max 20
To specify any or all of a date, a time, or a time period
1600
Request Validation
Max 9
To specify the validity of the request and indicate follow-up action authorized
1700
Vehicle Information
Max 1
To provide descriptions that identify a specific vehicle
1800
Product/Item Description
Max 1
To describe a product or process in coded or free-form format
1900
Property Description - Real
Max 1
To provide a description of real property
2000
Property Description - Personal
Max 1
To provide a description of personal property
2100
Item Identification
Max 1
To specify basic item identification data
2200
Equipment Characteristics
Max 1
To send additional information regarding a specific piece of equipment
2300
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
2400
Packaging Description
Max 1
To specify a package description and other information
2500
Message Text
Max 10
To provide a free-form format that allows the transmission of text information
2550
Tooth Identification
Max >1
To identify a tooth by number and, if applicable, one or more tooth surfaces
2115 Loop
Repeat >1
2600
Information
Max 1
To report information
2700
Date or Time or Period
Max 5
To specify any or all of a date, a time, or a time period
2800
Monetary Amount Information
Max 5
To indicate the total monetary amount
2900
Percent Amounts
Max 5
To qualify percent amounts and supply percent amounts
2117 Loop
Repeat >1
3000
Industry Code Identification
Max 1
To identify standard industry codes
3100
Monetary Amount Information
Max 5
To indicate the total monetary amount
3200
Percent Amounts
Max 5
To qualify percent amounts and supply percent amounts
3300
Loop Header
Max 1
To indicate that the next segment begins a loop
2120 Loop
Repeat >1
3400
Individual or Organizational Name
Max 1
To supply the full name of an individual or organizational entity
3500
Additional Name Information
Max 1
To specify additional names
3600
Party Location
Max 1
To specify the location of the named party
3700
Geographic Location
Max 1
To specify the geographic place of the named party
3800
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be directed
3900
Provider Information
Max 1
To specify the identifying characteristics of a provider
4000
Loop Trailer
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)
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.