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 technical reports have been developed by X12's Insurance subcommittee and were recently the subject of public review. The public review comments and associated work group responses will be reviewed at the informational forum. This is the final opportunity for public discussion of the comments and any resulting revisions.
The draft revisions, submitted comments, and associated responses are available at http://forums.x12.org until the conclusion of the informational forum. The draft is provided for public review and cannot be used for any other purpose without permission from X12. Responses to all comments will be posted no later than fifteen (15) days prior to the informational forum.
Individuals who will not be onsite at the Standing Meeting may participate in this informational forum virtually. To participate virtually, register here by August 21, 2019.