Eligibility Inquiry Transaction (Batch)
The ASC X12N 270 Eligibility Inquiry Transaction set is used to transmit health care eligibility benefit inquiries from health care providers, clearinghouses and other health care adjudication processors.
- The 13-Month Rule – The only time to get 13 months of retrospective eligibility is at the beginning of a month. Checking at the end of the month allows you to review the past 12 months in addition to the upcoming month. Eligibility is updated toward the end of the month.
- Type of insurance plan.
- Type of service performed.
- Where the service is performed.
- Where the inquiry is initiated.
- Where the inquiry is sent. When identifying a recipient/subscriber based on the information on a 270 request, the following combinations of data are valid:
- Recipient ID only
- SSN and DOB
- SSN and name
- DOB and name
- No more than 99 inquiries per ST-SE transaction set
Eligibility Inquiry Transaction
The ASC X12N 271 Eligibility Response Transaction set is used to respond to health care eligibility benefit inquiries as the appropriate mechanism.
The eligibility information returned is not a guarantee of claims payment. A value of 1 will be returned in the 271 response for a member with active coverage. This is indicated in loop 2110C-EB01.
To learn more about EDI and become a certified EDI Professional, please visit our course schedule page.