EDI 271 Eligibility%2c Coverage Or Benefit Information
This X12 Transaction Set contains the format and establishes the data contents of the Eligibility, Coverage or Benefit Information Transaction Set (271) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to communicate information about or changes to eligibility, coverage or benefits from information sources (such as - insurers, sponsors, payors) to information receivers (such as - physicians, hospitals, repair facilities, third party administrators, governmental agencies). This information includes but is not limited to: benefit status, explanation of benefits, coverages, dependent coverage level, effective dates, amounts for co-insurance, co-pays, deductibles, exclusions and limitations.
Segments
Position
Segment
Name
Max use
Mandatory
AtMax 1
To indicate the start of a transaction set and to assign a control number
Mandatory
AtMax 1
To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time
2000
LOOP
Mandatory
GT 1
Opt
AtMax 1
To indicate that the next segment begins a loop
2120
LOOP
Opt
GT 1
Opt
AtMax 1
To indicate that the loop immediately preceding this segment is complete
Mandatory
AtMax 1
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)