Eligibility / Benefits
The ASC X12N Health Care Eligibility Benefit Inquiry and Response (270/271) is a paired transaction set consisting of an Inquiry (270) and a Response (271).
The Inquiry is used to request information about a patient’s eligibility and coverage for health insurance for a specific payer or health plan and the associated policy benefits. The Inquiry can be for a single date or for a date range.
The Response is used to communicate the patient’s eligibility status for coverage in the health insurance plan (or plans) for the requested date or date range. For each plan under which the patient is covered (for example, a medical plan and a dental plan), the Response also provides details about the services which are covered; the benefits associated with those services; and financial information related to patient; for example:
- Deductibles and remaining deductibles
- Out of pocket amounts
The Response can include other information pertinent to the patient’s coverage, such as the patient’s primary care provider and other payers under whom the patient may have coverage.