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WPC 270/271-2011

Health Care Eligibility Benefit Inquiry and Response (270/271) - Combining two of ASC X12's documents: April 2008's 005010X279 and June 2010's 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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Washington Publishing Company [WPC]


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