Announcing a Public Review Period for the Health Care Eligibility/Benefit Inquiry and Information Response

The Health Care Eligibility/Benefit Inquiry and Information Response (270/271) Implementation Guide (007030X332) and the Code Value Usage in Eligibility Benefit Inquiry and Subsequent Response (007030X347) will be available for public review beginning July 16, 2018. The review period will close November 16, 2018 at 8:00 PM, Eastern Time. These technical reports have been developed by X12's Insurance subcommittee based on version 007030 of the X12 Standard. Following this review period, X12 will conduct a corresponding Informational Forum. The Informational Forum is the final opportunity for public discussion of the review comments and resulting revisions.

7/16/2018

The Health Care Eligibility/Benefit Inquiry and Information Response Implementation Guide describes the use of the Eligibility, Coverage or Benefit Inquiry (270) transaction set and the Eligibility, Coverage, or Benefit Information (271) transaction set for the following business usages:

  • Determine if an Information Source organization, such as an insurance company, has a particular subscriber or dependent on file
  • Determine the details of health care eligibility and/or benefit information

The Code Value Usage in Eligibility Benefit Inquiry and Subsequent Response Type 2 Technical Report (TR2) provides explanation, and where necessary, identifies requirements that must be supported when conducting transaction set exchanges involving the Health Care Eligibility, Coverage, or Benefit Inquiry (270) and Health Care Eligibility, Coverage, or Benefit Information (271) transaction sets. The Type 3 Technical Report was designed to give guidance on how these transaction sets should be implemented in the health care industry, while this TR2 defines where data is put and when it is included with the 270/271 transaction sets for the purpose of conveying health care eligibility and benefit information. This paired transaction set is comprised of two transactions: the 270, which is used to request (inquire) information, and the 271, which is used to respond with coverage, eligibility, and benefit information. The official names for these transactions are:

  • X12 - Eligibility, Coverage, or Benefit Inquiry (270)
  • X12 - Eligibility, Coverage, or Benefit Information (271)

These draft guides will be available in an on-line forum at http://forums.x12.org. The draft information is provided for public review and cannot be used for any other purpose without permission from X12. Reviewers may submit comments on the draft via the on-line forum. Instructions for reviewing the pages and submitting comments are posted on the forums page.

Interested parties may monitor all submitted comments and the associated responses via the on-line forum during the public review period and prior to the Informational Forum. Watch for the announcement of the corresponding Informational Forum.

Questions may be directed to info@x12.org.