This Draft Standard for Trial Use contains the format and establishes the data contents of the Eligibility, Coverage or 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 information about or changes to eligibility, coverage or benefits from information sources (such as - insurers, sponsors, payors) to information receivers (such as - physicians, hospitals, repair facilities, third party administrators, governmental agencies). This information includes but is not limited to: benefit status, explanation of benefits, coverages, dependent coverage level, effective dates, 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 define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time
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 indicate follow-up action authorized
To supply the full name of an individual or organizational entity
To specify identifying information
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 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 the delivery pattern of health care services
To specify identifying information
To specify any or all of a date, a time, or a time period
To specify the validity of the request and indicate follow-up action authorized
To provide descriptions that identify a specific vehicle
To describe a product or process in coded or free-form format
To provide a description of real property
To provide a description of personal property
To specify basic item identification data
To send additional information regarding a specific piece of equipment
To provide safety data information to recipients of the transaction, including identification of the hazard that the material being described represents, and the organization or party which declared this material to be a hazard or established exposure limits or other guidelines for that material
To specify a package description and other information
To provide a free-form format that allows the transmission of text information
To report information
To specify any or all of a date, a time, or a time period
To indicate the total monetary amount
To qualify percent amounts and supply percent amounts
Code to transmit standard industry codes
To indicate the total monetary amount
To qualify percent amounts and supply percent amounts
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 specify the identifying characteristics of a provider
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)
