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. If you are researching the 271s, you can view other trading partner's mapping specifications. 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

Lookup StandardEntire Segment
ViewST*271*000000001*005010X279A1
ViewBHT*0022*11*fp8R5D6898*20191215*224902
ViewHL*1**20*1
ViewNM1*PR*2*AETNA INC*****PI*953402799
ViewHL*2*1*21*1
ViewNM1*1P*1*Morley*Ronald****XX*1538215140
ViewHL*3*2*22*0
ViewNM1*IL*1*HENDRICKS*MELISSA****MI*W211229741
ViewREF*18*0866345
ViewREF*6P*086634502400044*TRS-ACTIVECARE
ViewN3*2450 WINDSOR ROAD
ViewN4*ABILENE*TX*79605
ViewDMG*D8*19660829*F
ViewINS*Y*18*001*25
ViewDTP*346*D8*20150901
ViewDTP*472*D8*20191105
ViewDTP*356*D8*20140901
ViewEB*L*ECH*30*EP
ViewMSG*PCP SELECTION NOT REQUIRED
ViewEB*W
ViewLS*2120
ViewNM1*PR*2*Aetna
ViewN3*PO Box 981106
ViewN4*El Paso*TX*79998
ViewLE*2120
ViewEB*1*ECH*30*EP*Open Access Aetna Select
ViewEB*C*FAM*30***25*3600*****Y
ViewDTP*346*D8*20190901
ViewMSG*Med Dent,All Other In-Network Providers
ViewEB*C*FAM*30***29*3571.72*****Y
ViewMSG*Med Dent
ViewEB*C*IND*30***25*1200*****Y
ViewDTP*346*D8*20190901
ViewMSG*Med Dent,All Other In-Network Providers
ViewEB*C*IND*30***29*1171.72*****Y
ViewMSG*Med Dent
ViewEB*G*IND*30****7900*****Y
ViewMSG*All Other In-Network Providers
ViewEB*G*IND*30***29*6849.33*****Y
ViewEB*G*FAM*30****15800*****Y
ViewMSG*All Other In-Network Providers
ViewEB*G*FAM*30***29*13937.6*****Y
ViewEB*F*ECH*30
ViewMSG*Our records indicate the provider ID you entered includes both in-network and out of network providers. Services rendered by providers that are not part of the patient's network are not covered.
ViewEB*H*ECH*30***32
ViewEB*1*ECH*98
ViewEB*A*ECH*98*****0****Y
ViewMSG*All Other In-Network Providers
ViewMSG*GYN Visit
ViewMSG*Specialist Visit or Evaluation
ViewMSG*Primary Care Visit or Evaluation
ViewIII*ZZ*11
ViewEB*A*ECH*98*****0****Y
ViewMSG*All Other In-Network Providers
ViewMSG*Walk In Clinic Visit
ViewEB*B*ECH*98****30*****Y
ViewMSG*All Other In-Network Providers
ViewMSG*GYN Visit,COPAY INCLUDED IN OOP
ViewMSG*Primary Care Visit or Evaluation,COPAY INCLUDED IN OOP
ViewIII*ZZ*11
ViewEB*B*ECH*98****30*****Y
ViewMSG*All Other In-Network Providers
ViewMSG*Walk In Clinic Visit,COPAY INCLUDED IN OOP
ViewEB*B*ECH*98****70*****Y
ViewMSG*All Other In-Network Providers
ViewMSG*Specialist Visit or Evaluation,COPAY INCLUDED IN OOP
ViewIII*ZZ*11
ViewEB*F*ECH*98*********Y
ViewMSG*All Other In-Network Providers
ViewMSG*GYN Visit/Plan Ded Waived
ViewMSG*Specialist Visit or Evaluation/Plan Ded Waived
ViewMSG*Primary Care Visit or Evaluation/Plan Ded Waived
ViewIII*ZZ*11
ViewEB*F*ECH*98*********Y
ViewMSG*All Other In-Network Providers
ViewMSG*Walk In Clinic Visit/Plan Ded Waived
ViewEB*F*ECH*98*********Y
ViewMSG*Plan Requires PreCert
ViewEB*F*ECH*98
ViewMSG*Self Funded
ViewEB*I*ECH*98*********N
ViewSE*82*000000001

Solutions:
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