EDI 271 Sample Data for the Eligibility, Coverage Or Benefit Information Transaction Set


AgencySet IDFGTransaction DescriptionSubcommitteeStandard
ANSI271HBEligibility, Coverage Or Benefit Information InsuranceDownload


Official Definition:
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.

Example of an EDI 271 Transaction Set

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ST*271*0001*005010X279A1
BHT*0022*06*A1B2C3D4E5*01010101*01010101
HL*A1B2C3D4E5**20*0
AAA*N**04*C
NM1*2B*1*A1B2C3D4E5*A1B2C3D4E5*A1B2C3D4E5**A1B2C3D4E5*24*A1B2C3D4E5
PER*IC*A1B2C3D4E5*ED*A1B2C3D4E5*ED*A1B2C3D4E5*ED*A1B2C3D4E5
AAA*N**04*C
HL*A1B2C3D4E5**20*0
AAA*N**04*C
NM1*2B*1*A1B2C3D4E5*A1B2C3D4E5*A1B2C3D4E5**A1B2C3D4E5*24*A1B2C3D4E5
PER*IC*A1B2C3D4E5*ED*A1B2C3D4E5*ED*A1B2C3D4E5*ED*A1B2C3D4E5
AAA*N**04*C
HL*A1B2C3D4E5*A1B2C3D4E5*21*0
NM1*1P*1*A1B2C3D4E5*A1B2C3D4E5*A1B2C3D4E5**A1B2C3D4E5*24*A1B2C3D4E5
REF*0B*A1B2C3D4E5*A1B2C3D4E5
N3*1 OPEN AVENUE*1 OPEN AVENUE
N4*PARIS*CA*91506*IDI
LE*A1B2
SE*19*0001

Solutions:
Are you looking to trade the EDI 271 transaction with one of your trading partners? Do you need an EDI VAN Savings solution to exchange the 271? Or perhaps you would like to use a Cloud-Based application, so you can plug your 271 transaction directly into your ERP and TMS systems. Even small companies have the ability to trade the 271 using an EDI Web Browser solution.



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