EDI Verification

EDI for Eligibility & Benefits Verification (HIPAA Standard 270/271 Eligibility Transactions)

Requests for eligibility status for a single commercial, Medicare or state health programs member transaction may be submitted by registered participating providers on the Health Net provider website.

To request eligibility and obtain eligibility information for multiple members at one time, providers can use the 270/271 eligibility transaction through one of two electronic clearinghouses. A 270 request provides eligibility verification information directly to providers through a real-time link. Providers submit a request for a single HIPAA standard 270 or multiple 270s and obtain the 271 responses from Health Net online.

271 responses are also compliant with the Council for Affordable Quality Healthcare (CAQH®)/Committee on Operating Rules for Information Exchange (CORETM) Phase II requirements.

In accordance with the Health Insurance Portability and Accountability Act (HIPAA) privacy requirements for submission of electronic health care transactions, Health Net is compliant in meeting and adopting the 270/271 eligibility transaction standards as outlined by HIPAA and with the Administration Simplication Operating rules for eligibility and health care claim status transactions.

To learn more about EDI and become a certified  EDI Professional please visit our course schedule page.

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