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


AgencySet IDFGTransaction DescriptionSubcommittee
ANSI271HBEligibility, Coverage Or Benefit Information Insurance


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Research and Development:
Below is a sample EDI 271 transaction set. The Jobisez.com site has an online translation tool that converts the EDI 271 (Eligibility, Coverage Or Benefit Information) document into a CSV file. You can also gain knowledge by researching all EDI Document Types. Jobisez LLC can also provide assistance if you need additional help.

Sample of an EDI 271 Transaction Set

SegmentEntire Segment
ViewST*271*000000001*005010X279A1
ViewBHT*0022*11*7237581e2e400890ee96a51bc62ed0*20200308*1901
ViewHL*1**20*1
ViewNM1*PR*2*CMS*****PI*CMS
ViewHL*2*1*21*1
ViewNM1*1P*2*SINAI HADASSAH MEDICAL ASSOCIATES*****XX*1508165317
ViewHL*3*2*22*0
ViewTRN*1*2223255592*99Trizetto
ViewNM1*IL*1*BELMAR*ALBERT*R***MI*9UY4R33KV83
ViewN3*1029 SALEM AVE
ViewN4*WOODBURY*NJ*080966062
ViewDMG*D8*19500722*M
ViewDTP*307*RD8*20191230-20191230
ViewEB*1**88
ViewEB*1**30^42^45^48^49^69^76^83^A5^A7^AG^BT^BU^BV*MA
ViewDTP*291*D8*20150701
ViewEB*1**30^2^23^24^25^26^27^28^3^33^36^37^38^39^40^42^50^51^52^53^67^69^73^76^83^86^98^A4^A6^A8^AI^AJ^AK^AL^BT^BU^BV^DM^UC*MB
ViewDTP*291*D8*20150701
ViewEB*A**30*QM*Medicare Part B*27**0
ViewDTP*291*RD8*20190101-20191231
ViewEB*C**30*QM*Medicare Part A*26*0
ViewDTP*291*RD8*20190101-20191231
ViewEB*C**30*QM*Medicare Part B*23*0
ViewDTP*291*RD8*20190101-20191231
ViewEB*I**41^54
ViewEB*R***QM*NJ QMB Plan
ViewDTP*290*D8*20170201
ViewEB*R**88*OT
ViewREF*18*S5601
ViewREF*N6*008*SilverScript Choice
ViewDTP*292*D8*20170101
ViewLS*2120
ViewNM1*PR*2*SILVERSCRIPT INSURANCE COMPANY
ViewN3*445 Great Circle Road
ViewN4*Nashville*TN*37228
ViewPER*IC**TE*8664430934*UR*www.silverscript.com
ViewLE*2120
ViewSE*38*000000001

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