X12 270/271 Eligibility

1. 270 inquiry structure

   Information source, receiver, subscriber and dependent loops, EQ service type code and DMG demographics.

2. 271 response structure

   EB eligibility or benefit information segments, MSG messages, and AAA rejection reasons.

3. Service type codes

   Service type codes such as 30 health benefit plan coverage and 98 professional visit.

4. Coverage and benefit details

   EB01 eligibility code, coverage level, plan description, copay, coinsurance, deductible and benefit amounts.

5. Eligibility in Medicare

   Medicare Claims Processing Manual chapter on non-claim HIPAA transactions.

6. FHIR equivalent

   CoverageEligibilityRequest and CoverageEligibilityResponse mapping to 270/271.

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