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WPC, Washington Publishing Company, is the exclusive publisher for the ASC X12 Insurance subcommittee, X12N. Founded in 1975, WPC provides documentation adopted under the Health Insurance Portability and Accountability Act (HIPAA) and other related, value-added documents, such as the WPC Combined EDI Guides. The set of Combined EDI Guides includes material covering Health Care Eligibility Benefit Inquiries. Standards from WPC are available both individually, directly through the ANSI webstore, and as part of a Standards Subscription. If you or your organization are interested in easy, managed, online access to standards that can be shared, a Standards Subscription may be what you need - please contact us at: StandardsSubscriptions@ansi.org or 1-212-642-4980 or Request Proposal Price.

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WPC 270/271-2011

Health Care Eligibility Benefit Inquiry and Response (270/271) - Combining two of ASC X12Æs documents: April 2008Æs 005010X279 and June 2010Æs 005010X279A1

The purpose of this implementation guide is to explain the developers' intent when the Health Care Eligibility, Coverage, or Benefit Inquiry (270) and Health Care Eligibility, Coverage, or Benefit Information (271) transaction sets were designed and to give guidance on how they should be implemented in the health care industry. Specifically, this guide defines where data is put and when it is included for the ANSI ASC X12.281 and X12.282 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: ANSI ASC X12.281 - Eligibility, Coverage, or Benefit Inquiry (270) ANSI and ASC X12.282 - Eligibility, Coverage, or Benefit Information (271). This implementation guide is intended to provide assistance in the development and use of the electronic transfer of health care eligibility and benefit information. It is hoped that the entities that exchange eligibility information will work to develop and exchange standard formats within the health care industry and among their trading partners.


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