Eligibility, Coverage or Benefit Information
The HIPAA X12 271 is the payer's response to a 270 inquiry, detailing whether the patient is covered and describing plan benefits, copays, and limitations.
In this guide
271 Eligibility Response moves from Payer / Health Plan to Provider / Clearinghouse (Payer → Provider) via AS2, SFTP, API, Clearinghouse. The interactive diagram below traces every business and technical step the message passes through — press Play Flow to watch it travel, or click any step for detail.
How it works
How 271 Eligibility Response Works
Sender
Payer / Health Plan
Receiver
Provider / Clearinghouse
Direction
Payer → Provider
Standard
ANSI ASC X12
Version
005010X279A1
Transport
AS2 / SFTP / API / Clearinghouse
Business Purpose
Healthcare
Sender — Payer / Health Plan
EDI Transmission
271
Eligibility, Coverage or Benefit Information
ANSI ASC X12 005010X279A1
Receiver — Provider / Clearinghouse
Related transaction flows
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Ask EDI AI →271 Eligibility Response workflow. Steps: Receive 270 Inquiry, Compile Benefits, Generate 271 Response, Return via Clearinghouse, Provider System Receives, Display at Front Desk. Transmitted from Payer / Health Plan to Provider / Clearinghouse via AS2, SFTP, API, Clearinghouse, following ANSI ASC X12 005010X279A1.
Overview
Gives providers the coverage details needed to estimate patient responsibility and avoid providing services that won't be reimbursed.
Sender
Payer / Health Plan
Receiver
Provider / Clearinghouse
Direction
Payer → Provider
Standard / Version
ANSI ASC X12 005010X279A1
Segment structure
Key segments that make up this transaction set:
| Segment | Name | Purpose |
|---|---|---|
| BHT | Beginning of Hierarchical Transaction | References the original inquiry. |
| HL | Hierarchical Level | Mirrors the 270 structure (payer, provider, subscriber). |
| EB | Eligibility or Benefit Information | States the coverage status and specific benefit values (copay, deductible, etc.). |
| MSG | Message Text | Free-text plan notes when structured codes aren't sufficient. |
Interactive example
Click any segment below to see its business meaning.
ST
This is an envelope or control segment. Select a highlighted segment on the left (shown in green) for a full business explanation.
View raw EDI
ST*271*0001*005010X279A1~
BHT*0022*11*INQ-4471*20230920*0901~
HL*1**20*1~
NM1*PR*2*Acme Health Plan*****PI*66783~
HL*2*1*21*1~
NM1*1P*2*Riverside Medical Group*****XX*1932837465~
HL*3*2*22*0~
NM1*IL*1*DOE*JANE****MI*W123456789~
DMG*D8*19850612*F~
EB*1**30**Gold PPO Plan~
EB*B**30**Gold PPO Plan*27*30~
SE*11*0001~Mapping example
A representative field-level mapping from a common source system into this transaction:
| Source | Source Field | Target Field |
|---|---|---|
| Payer Eligibility Engine | coverage.status | EB01 (Eligibility or Benefit Information Code) |
| Payer Eligibility Engine | benefit.copay_amount | EB07 (Monetary Amount) |
Validation rules
- At least one EB segment with code 1 (Active) or 6 (Inactive) must be present to state overall coverage status.
- Dollar amounts in EB07 must be non-negative and consistent with the plan's published benefit summary.
- The transaction must echo the same subscriber identifiers received on the 270.
Common errors & troubleshooting
Front desk sees coverage but no copay amount
Cause: Payer's system only returned a general active-coverage EB segment without a benefit-specific EB for the requested service type.
Fix: Confirm the payer supports service-type-specific benefit detail for the EQ codes being queried.
Automated intake tool shows the patient as inactive
Cause: 271 correctly reports inactive coverage as of the response date because the query date fell outside the coverage period.
Fix: This is often not a data error — verify plan effective/termination dates rather than treating it as a system failure.
Related articles
Frequently asked questions
It indicates the coverage is inactive — the patient does not currently have active benefits under the plan being queried.
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