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WPC 270/271-2003

Health Care Eligibility Benefit Inquiry and Response - Combining two of ASC X12NÆs documents: May 2000Æs 004010X092 and October 2002Æs 004010X092A1

The purpose of this implementation guide is to explain the developersÆ 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 ASC X12.282 - Eligibility, Coverage, or Benefit Information (271).


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