What is an EDI 271?

The Eligibility and Benefit Response (271) transaction is used to respond to a request inquiry about the health care eligibility and benefits associated with a subscriber or dependent.

What is an EDI 835?

The Electronic Remittance Advice (ERA), or 835, is the electronic transaction that provides claim payment information. These files are used by practices, facilities, and billing companies to auto-post claim payments into their systems.

What is eligibility response?

The eligibility benefit/response transaction is used by health plans to respond to a health care provider’s (or another health plan’s) inquiry about an enrollee’s eligibility and coverage.

What is the purpose of EDI 270 / 271?

EDI 270/271: Eligibility and Benefit Inquiry and Response. Use the Eligibility and Benefit Inquiry (270) transaction to inquire about the health care eligibility and benefits associated with a subscriber or dependent. The Eligibility and Benefit Response (271) transaction is used to respond to a request inquiry about…

What is the X12 transaction set in EDI?

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.

What is the purpose of the 271 transaction set?

The 271 Transaction Set is the appropriate response mechanism for Health Care Eligibility Benefit Inquiries. There are several levels (i.e. Information Source, Information Receiver, Subscriber, etc.) at which a transaction can be rejected for incomplete or erroneously formatted inquiry information.

When to use eligibility and benefit ( 271 ) transaction?

The Eligibility and Benefit Response (271) transaction is used to respond to a request inquiry about the health care eligibility and benefits associated with a subscriber or dependent.