EDI 271
Healthcare Eligibility/ Benefit Response
The EDI 271 transaction is an electronic Healthcare Eligibilit/Benefit Response (also known as ANSI X12 EDI 271). An EDI 271 Healthcare Eligibility/ Benefit Response is sent in response to an EDI 270 transaction.
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What is an EDI 271?
The EDI 271 Health Care Eligibility/Benefit Response provides details on a patient’s insurance coverage in response to an EDI 270 inquiry. It is sent by insurance companies, Medicare, Medicaid, or other payers to healthcare providers to confirm eligibility and benefits.
How to use an EDI 271?
An EDI 271 Health Care Eligibility/Benefit Response is used by insurance providers to respond to an EDI 270 Health Care Eligibility/Benefit Inquiry inquiry from healthcare providers. It confirms a patient’s insurance coverage, detailing eligibility, covered services, copays, deductibles, and policy limitations. This transaction helps healthcare providers verify benefits in real-time, reducing claim denials, improving billing accuracy, and ensuring HIPAA compliance.
What Information Does the EDI 271 Include?
A 271 response typically contains:
- Sender details (insurance provider or payer)
- Recipient details (healthcare provider)
- Plan subscriber details (patient or dependent information)
- Eligibility and benefit details (covered services, copays, deductibles)
HIPAA Compliance and EDI 270/271
As of March 31, 2012, healthcare providers must comply with HIPAA version 5010 for EDI transactions. EDI/HQ™ Healthcare software ensures full HIPAA-compliant EDI processing, offering:
- Advanced EDI translation
- Superior mapping and integration
- Enhanced data management
Other Common X12 Transactions Related to EDI 271
View the most commonly used EDI transactions.
Cleo can assist with EDI 271s (and so much more)
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- Create and deploy your own integrations using Cleo's intuitive, self-service design platform.
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