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EDI 270/271: Eligibility and Benefit Inquiry and Response

Use the Eligibility and Benefit Inquiry (270) transaction to inquire about the health care eligibility and benefits associated with a subscriber or dependent.

The Eligibility and Benefit Response (271) transaction is used to respond to a request inquiry about the health care eligibility and benefits associated with a subscriber or dependent.

You can obtain detailed benefit information including member ID number, date of coverage, copayment, year-to-date deductible amount, and commercial coordination of benefit (COB) information when applicable.

Physicians and other health care professionals can perform eligibility (270/271) transactions in batch or real-time mode, based on your connectivity method.

Benefits

Electronic eligibility verification may result in the following benefits:

  • Reduced collection and billing costs
  • Decreased bad debt
  • Improved cash flow
  • Increased productivity and efficiency
  • Fewer rejected claims
  • Less time spent on manual, administrative tasks
  • Expedited reimbursement
  • Available to participating and non-participating health care professionals

Getting Started

Contact your software vendor or clearinghouse. If available, eligibility transactions may be integrated into your Practice Management System or Hospital Information System. This allows systems to automatically generate an inquiry and/or to enable automatic posting of the benefit information to patient accounts. Many vendors and clearinghouses also offer multi-payer, web-based batch or real-time eligibility solutions.

Helpful Resources