271 Examples on Healthcare Data Insight

X12 EDI Examples: 270 Clinic Subscriber Eligibility Request

Mon, 01 Jan 0001 00:00:00 +0000

270 Eligibility Request - Clinic Subscriber Inquiry

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This is an eligibility request from a clinic to a payer. The clinic is checking whether the subscriber, who is also the patient, has coverage for a generic eligibility inquiry.

X12 EDI Examples: 270 Physician Dependent Eligibility Request

Mon, 01 Jan 0001 00:00:00 +0000

270 Eligibility Request - Physician Dependent Inquiry

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This is an eligibility request from an individual provider to a payer. The physician is checking whether a dependent patient has coverage using a generic eligibility inquiry.

X12 EDI Examples: 271 Clinic Subscriber Eligibility Response

Mon, 01 Jan 0001 00:00:00 +0000

271 Eligibility Response - Clinic Subscriber Coverage

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This is a payer response to the clinic subscriber eligibility request. It shows the subscriber’s active coverage, plan information, benefit categories, and related primary care provider information.

X12 EDI Examples: 271 Payer Eligibility Inquiry Error Response

Mon, 01 Jan 0001 00:00:00 +0000

271 Eligibility Error Response - Provider Not Eligible

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This is an eligibility response from a payer to a clinic based on a prior request. The response uses the request validation segment to indicate that the provider is not eligible to submit eligibility inquiries to the payer.

X12 EDI Examples: 271 Physician Dependent Eligibility Response

Mon, 01 Jan 0001 00:00:00 +0000

271 Eligibility Response - Physician Dependent Coverage

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This is a payer response to a physician’s eligibility inquiry for a dependent patient. It shows active health plan coverage, eligibility dates, benefit categories, and primary care provider information.