Eligibility transaction (270/271)
The eligibility transaction — the X12 270 inquiry and 271 response — is the electronic exchange that lets a provider verify a patient's coverage and benefits with a payer in real time or batch.
Updated
The eligibility transaction is the HIPAA-standard electronic exchange for coverage verification: a provider (or its clearinghouse) sends an X12 270 inquiry asking whether a patient is covered, and the payer returns an X12 271 response with active/inactive status, plan information, and, depending on the inquiry and the payer's response, benefit details such as copays, deductibles, and coverage limits.
It is one of the HIPAA-mandated transactions, so payers that conduct it electronically must support the standard. The 271's depth — whether it returns benefit detail beyond active coverage — depends on the inquiry sent and the payer's response, and is governed by the payer's companion guide as well as the standard.
In practice
The 270/271 is the workhorse of front-desk verification: it confirms coverage on or near the date of service, surfaces the plan that should be billed, and gives the cost-sharing information that lets a practice estimate patient responsibility before the visit. A response that shows only active/inactive status (without benefit detail) is still a valid 271, just a less informative one.
Commonly confused with
- Benefit verification: Eligibility verification confirms whether coverage is active and under what plan; benefit verification is the broader inquiry into what the plan covers and what the patient owes — often carried by the same 270/271 transaction but a deeper question.
- Claim status transaction (276/277): The 270/271 verifies coverage before a claim; the 276/277 asks the status of a claim already submitted. They are different transactions answering different questions.