This Draft Standard for Trial Use contains the format and establishes the data contents of the Health Care Eligibility/Benefit Information Transaction Set (271) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to communicate from health care information sources (i.e. - insurers, sponsors, payors) to health care information receivers (i.e. - physicians, hospitals, medical facilities) information about or changes to health care eligibility or benefits. This information includes but is not limited to: benefit status, explanation of benefit status, dependent coverage level, dates of coverage, covered days and/or non-covered days, amounts for co-insurance, co-pays, deductibles, exclusions and limitations.
To indicate the start of a transaction set and to assign a control number
To indicate the beginning of a transaction set.
To identify dependencies among and the content of hierarchically related groups of data segments.
To uniquely identify a transaction to an application.
To specify the validity of the request and to indicate follow-up action authorized.
To supply the full name of an individual or organizational entity
To specify identifying numbers.
To specify additional names or those longer than 35 characters in length
To specify the location of the named party
To specify the geographic place of the named party
To identify a person or office to whom administrative communications should be directed
To specify the validity of the request and to indicate follow-up action authorized.
To specify the identifying characteristics of a provider
To supply demographic information
To provide benefit information on insured entities
To specify any or all of a date, a time, or a time period
To supply eligibility or benefit information
To specify identifying numbers.
To specify any or all of a date, a time, or a time period
To specify the validity of the request and to indicate follow-up action authorized.
To provide a free form format that would allow the transmission of text information.
To indicate that the next segment begins a loop
To supply the full name of an individual or organizational entity
To specify additional names or those longer than 35 characters in length
To specify the location of the named party
To specify the geographic place of the named party
To identify a person or office to whom administrative communications should be directed
To indicate that the loop immediately preceding this segment is complete
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments).
