271Health Care Eligibility/Benefit Information

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.

  • ST
    Transaction Set Header
    M必须(Mandatory)
    Repeat 1

    To indicate the start of a transaction set and to assign a control number

  • BGN
    Beginning Segment
    O可选(Optional)
    Repeat 1

    To indicate the beginning of a transaction set.

  • HLLoop1Hierarchical Level LOOPM必须(Mandatory)Repeat > 1
    HLTRNAAANM1Loop1
    • HL
      Hierarchical Level
      M必须(Mandatory)
      Repeat 1

      To identify dependencies among and the content of hierarchically related groups of data segments.

    • TRN
      Trace
      O可选(Optional)
      Repeat 9

      To uniquely identify a transaction to an application.

    • AAA
      Request Validation
      O可选(Optional)
      Repeat 9

      To specify the validity of the request and to indicate follow-up action authorized.

    • NM1Loop1Individual or Organizational Name LOOPO可选(Optional)Repeat > 1
      NM1REFN2N3N4PERAAAPRVDMGINSDTPEBLoop1
      • NM1
        Individual or Organizational Name
        M必须(Mandatory)
        Repeat 1

        To supply the full name of an individual or organizational entity

      • REF
        Reference Numbers
        O可选(Optional)
        Repeat 9

        To specify identifying numbers.

      • N2
        Additional Name Information
        O可选(Optional)
        Repeat 1

        To specify additional names or those longer than 35 characters in length

      • N3
        Address Information
        O可选(Optional)
        Repeat 1

        To specify the location of the named party

      • N4
        Geographic Location
        O可选(Optional)
        Repeat 1

        To specify the geographic place of the named party

      • PER
        Administrative Communications Contact
        O可选(Optional)
        Repeat 3

        To identify a person or office to whom administrative communications should be directed

      • AAA
        Request Validation
        O可选(Optional)
        Repeat 9

        To specify the validity of the request and to indicate follow-up action authorized.

      • PRV
        Provider Information
        O可选(Optional)
        Repeat 1

        To specify the identifying characteristics of a provider

      • DMG
        Demographic Information
        O可选(Optional)
        Repeat 1

        To supply demographic information

      • INS
        Insured Benefit
        O可选(Optional)
        Repeat 1

        To provide benefit information on insured entities

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat 9

        To specify any or all of a date, a time, or a time period

      • EBLoop1Eligibility or Benefit Information LOOPO可选(Optional)Repeat > 1
        EBREFDTPAAAMSGLSLoop1
        • EB
          Eligibility or Benefit Information
          M必须(Mandatory)
          Repeat 1

          To supply eligibility or benefit information

        • REF
          Reference Numbers
          O可选(Optional)
          Repeat 9

          To specify identifying numbers.

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat 20

          To specify any or all of a date, a time, or a time period

        • AAA
          Request Validation
          O可选(Optional)
          Repeat 9

          To specify the validity of the request and to indicate follow-up action authorized.

        • MSG
          Message Text
          O可选(Optional)
          Repeat 10

          To provide a free form format that would allow the transmission of text information.

        • LSLoop1Loop Header LOOPO可选(Optional)Repeat 1
          LSNM1Loop2LE
          • LS
            Loop Header
            M必须(Mandatory)
            Repeat 1

            To indicate that the next segment begins a loop

          • NM1Loop2Individual or Organizational Name LOOPO可选(Optional)Repeat 1
            NM1N2N3N4PER
            • NM1
              Individual or Organizational Name
              M必须(Mandatory)
              Repeat 1

              To supply the full name of an individual or organizational entity

            • N2
              Additional Name Information
              O可选(Optional)
              Repeat 1

              To specify additional names or those longer than 35 characters in length

            • N3
              Address Information
              O可选(Optional)
              Repeat 1

              To specify the location of the named party

            • N4
              Geographic Location
              O可选(Optional)
              Repeat 1

              To specify the geographic place of the named party

            • PER
              Administrative Communications Contact
              O可选(Optional)
              Repeat 3

              To identify a person or office to whom administrative communications should be directed

          • LE
            Loop Trailer
            M必须(Mandatory)
            Repeat 1

            To indicate that the loop immediately preceding this segment is complete

  • SE
    Transaction Set Trailer
    M必须(Mandatory)
    Repeat 1

    To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments).

Segment
X12 EDI Release 00304
To indicate the start of a transaction set and to assign a control number
Elements
  • ST01143Transaction Set Identifier Code
    ID
    M必须(Mandatory)
    Min 3 / Max 3

    Code uniquely identifying a Transaction Set.

    Codes (320)
  • ST02329Transaction Set Control Number
    AN
    M必须(Mandatory)
    Min 4 / Max 9

    Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set

  • ST031705Implementation Convention Preference
    AN
    O可选(Optional)
    Min 1 / Max 9