X12 HIPAA 271 Generic Response

The EDI 271 Health Care Eligibility/Benefit Response transaction set is used to provide information about healthcare policy coverages relative to a specific subscriber or the subscriber’s dependent seeking medical services. It is sent in response to a 270 inquiry transaction.

This transaction is typically sent by insurance companies, government agencies like Medicare or Medicaid, or other organizations that would have information about a given policy. It is sent to healthcare service providers, such as hospitals or medical clinics that inquire to ascertain whether and to what extent a patient is covered for certain services. The 271 document typically includes the following:

• Details of the sender of the inquiry (name and contact information of the information receiver)
• Name of the recipient of the inquiry (the information source)
• Details of the plan subscriber about to the inquiry is referring
• Description of eligibility or benefit information requested

The combination of the 270 and 271 transaction sets represent the third-most used transactions in healthcare. Adoption of these transactions replaced the use of phone or fax for requesting and providing information on a patient’s coverage under a plan. 

X12 HIPAA 271 Specification

X12 HIPAA 271 specification is available at:

• EdiNation

X12 HIPAA 271 Code Example

X12 HIPAA 271 code example is available at:

• EDI Tools for .NET X12 HIPAA 271 parse & generate C# example

X12 HIPAA 271 Sample File

ISA*00*          *00*          *ZZ*1234567        *ZZ*11111          *170508*1141*>*00501*000000101*1*P*:~
GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X279A1~
ST*271*4321*005010X279A1~
BHT*0022*11*10001234*20060501*1319~
HL*1**20*1~
NM1*PR*2*ABC COMPANY*****PI*842610001~
HL*2*1*21*1~
NM1*1P*2*BONE AND JOINT CLINIC*****SV*2000035~
HL*3*2*22*0~
TRN*2*93175-012547*9877281234~
NM1*IL*1*SMITH*JOHN****MI*123456789~
N3*15197 BROADWAY AVENUE*APT 215~
N4*KANSAS CITY*MO*64108~
DMG*D8*19630519*M~
DTP*346*D8*20060101~
EB*1**30**GOLD 123 PLAN~
EB*L~
EB*1**1>33>35>47>86>88>98>AL>MH>UC~
EB*B**1>33>35>47>86>88>98>AL>MH>UC*HM*GOLD 123 PLAN*27*10*****Y~
EB*B**1>33>35>47>86>88>98>AL>MH>UC*HM*GOLD 123 PLAN*27*30*****N~
LS*2120~
NM1*P3*1*JONES*MARCUS****SV*0202034~
LE*2120~
SE*22*4321~
GE*1*101~
IEA*1*000000101~