271Eligibility, Coverage or Benefit Information

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.

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

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

  • BHT
    Beginning of Hierarchical Transaction
    M必须(Mandatory)
    Repeat 1

    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

  • 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 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 Identification
        O可选(Optional)
        Repeat 9

        To specify identifying information

      • 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 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
        EBHSDREFDTPAAAVEHPIDPDRPDPLINEMSD1PKDMSGIIILoop1LSLoop1
        • EB
          Eligibility or Benefit Information
          M必须(Mandatory)
          Repeat 1

          To supply eligibility or benefit information

        • HSD
          Health Care Services Delivery
          O可选(Optional)
          Repeat 9

          To specify the delivery pattern of health care services

        • REF
          Reference Identification
          O可选(Optional)
          Repeat 9

          To specify identifying information

        • 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 indicate follow-up action authorized

        • VEH
          Vehicle Information
          O可选(Optional)
          Repeat 1

          To provide descriptions that identify a specific vehicle

        • PID
          Product/Item Description
          O可选(Optional)
          Repeat 1

          To describe a product or process in coded or free-form format

        • PDR
          Property Description - Real
          O可选(Optional)
          Repeat 1

          To provide a description of real property

        • PDP
          Property Description - Personal
          O可选(Optional)
          Repeat 1

          To provide a description of personal property

        • LIN
          Item Identification
          O可选(Optional)
          Repeat 1

          To specify basic item identification data

        • EM
          Equipment Characteristics
          O可选(Optional)
          Repeat 1

          To send additional information regarding a specific piece of equipment

        • SD1
          Safety Data
          O可选(Optional)
          Repeat 1

          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

        • PKD
          Packaging Description
          O可选(Optional)
          Repeat 1

          To specify a package description and other information

        • MSG
          Message Text
          O可选(Optional)
          Repeat 10

          To provide a free-form format that allows the transmission of text information

        • IIILoop1Information LOOPO可选(Optional)Repeat > 1
          IIIDTPAMTPCTLQLoop1
          • III
            Information
            M必须(Mandatory)
            Repeat 1

            To report information

          • DTP
            Date or Time or Period
            O可选(Optional)
            Repeat 5

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

          • AMT
            Monetary Amount
            O可选(Optional)
            Repeat 5

            To indicate the total monetary amount

          • PCT
            Percent Amounts
            O可选(Optional)
            Repeat 5

            To qualify percent amounts and supply percent amounts

          • LQLoop1Industry Code LOOPO可选(Optional)Repeat > 1
            LQAMTPCT
            • LQ
              Industry Code
              M必须(Mandatory)
              Repeat 1

              Code to transmit standard industry codes

            • AMT
              Monetary Amount
              O可选(Optional)
              Repeat 5

              To indicate the total monetary amount

            • PCT
              Percent Amounts
              O可选(Optional)
              Repeat 5

              To qualify percent amounts and supply percent amounts

        • 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
            NM1N2N3N4PERPRV
            • 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

            • PRV
              Provider Information
              O可选(Optional)
              Repeat 1

              To specify the identifying characteristics of a provider

          • 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 00307
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