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Updated:05/16/2008

HIPAA 271 - Eligibility, Coverage or Benefit Information
Management Systems Consulting, Inc.
VERSION: 1.0 DRAFT

Author: Skip Stein

Notes: In order to protect the security and confidentiality of electronic health information, Congress has passed The Health Insurance Portability and Accountability Act, also known as HIPAA, which was the result of efforts by the Clinton Administration and congressional healthcare reform proponents to reform healthcare in a way that would streamline industry inefficiencies, reduce paperwork, make it easier to detect and prosecute fraud and abuse and enable workers of all professions to change jobs, even if they (or family members) had pre-existing medical conditions.

271
Eligibility, Coverage or Benefit Information
Functional Group=HB

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.

Heading:
Pos Id Segment Name Req Max Use Repeat Notes Usage
010 ST Transaction Set Header M 1
020 BHT Beginning of Hierarchical Transaction M 1
Detail:
Pos Id Segment Name Req Max Use Repeat Notes Usage
Loop ID - 2000A >1
010 HL Information Source Level M 1
025 AAA Request Validation O 9
Loop ID - 2100A 1
030 NM1 Information Source Name O 1
040 REF Information Source Additional Identification O 9
080 PER Information Source Contact Information O 3
085 AAA Request Validation O 9
Loop ID - 2000B >1
010 HL Information Receiver Level O 1
Loop ID - 2100B 1
030 NM1 Information Receiver Name O 1
040 REF Information Receiver Additional Identification O 9
085 AAA Information Receiver Request Validation O 9
Loop ID - 2000C >1
010 HL Subscriber Level O 1
020 TRN Subscriber Trace Number O 3 N2/020
Loop ID - 2100C 1
030 NM1 Subscriber Name O 1
040 REF Subscriber Additional Identification O 9
060 N3 Subscriber Address O 1
070 N4 Subscriber City/State/ZIP Code O 1
080 PER Subscriber Contact Information O 3
085 AAA Subscriber Request Validation O 9
100 DMG Subscriber Demographic Information O 1
110 INS Subscriber Relationship O 1
120 DTP Subscriber Date O 9
Loop ID - 2110C >1
130 EB Subscriber Eligibility or Benefit Information O 1
135 HSD Health Care Services Delivery O 9
140 REF Subscriber Additional Identification O 9
150 DTP Subscriber Eligibility/Benefit Date O 20
160 AAA Subscriber Request Validation O 9
250 MSG Message Text O 10
Loop ID - 2115C 10
260 III Subscriber Eligibility or Benefit Additional Information O 1
330 LS Loop Header O 1
Loop ID - 2120C 1
340 NM1 Subscriber Benefit Related Entity Name O 1
360 N3 Subscriber Benefit Related Entity Address O 1
370 N4 Subscriber Benefit Related City/State/ZIP Code O 1
380 PER Subscriber Benefit Related Entity Contact Information O 3
390 PRV Subscriber Benefit Related Provider Information O 1
400 LE Loop Trailer O 1
Loop ID - 2000D >1
010 HL Dependent Level O 1
020 TRN Dependent Trace Number O 3 N2/020
Loop ID - 2100D 1
030 NM1 Dependent Name O 1
040 REF Dependent Additional Identification O 9
060 N3 Dependent Address O 1
070 N4 Dependent City/State/ZIP Code O 1
080 PER Dependent Contact Information O 3
085 AAA Dependent Request Validation O 9
100 DMG Dependent Demographic Information O 1
110 INS Dependent Relationship O 1
120 DTP Dependent Date O 9
Loop ID - 2110D >1
130 EB Dependent Eligibility or Benefit Information O 1
135 HSD Health Care Services Delivery O 9
140 REF Dependent Additional Identification O 9
150 DTP Dependent Eligibility/Benefit Date O 20
160 AAA Dependent Request Validation O 9
250 MSG Message Text O 10
Loop ID - 2115D 10
260 III Dependent Eligibility or Benefit Additional Information O 1
330 LS Dependent Eligibility or Benefit Information O 1
Loop ID - 2120D 1
340 NM1 Dependent Benefit Related Entity Name O 1
360 N3 Dependent Benefit Related Entity Address O 1
370 N4 Dependent Benefit Related Entity City/State/ZIP Code O 1
380 PER Dependent Benefit Related Entity Contact Information O 3
390 PRV Dependent Benefit Related Provider Information O 1
400 LE Loop Trailer O 1
410 SE Transaction Set Trailer M 1

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