What are the 270 and 271 transactions?
The 270 asks a payer whether a patient's coverage is active and what it pays for; the 271 answers with the plan, network status, deductible, copay and coinsurance.
ST*271*0001*005010X279A1~Start of the 271 eligibility response.NM1*IL*1*SAMPLE*ALEX****MI*XEH481207733~The subscriber the payer found.EB*1**30**GOLD PPO~Active coverage (1) for health benefit plan coverage (30), plan Gold PPO.EB*C*IND*30***23*1500*****Y~Individual deductible (C) of $1,500 per calendar year (23), in network (Y).EB*C*IND*30***29*620*****Y~$620 of that deductible remains (29).EB*B*IND*98***27*30*****Y~Office visits (98): a $30 copay (B) per visit (27).EB*A*IND*98*****.2****Y~Office visits: 20% coinsurance (A).Checking eligibility before a service is the cheapest denial prevention there is. The 270/271 does it in seconds, through a clearinghouse or directly with the payer.
What a 271 can tell you
- Whether coverage is active on the date of service, and under which plan.
- Network status, and whether the plan is a Medicare Advantage or managed Medicaid plan.
- The deductible, how much of it is met, copays, coinsurance and out-of-pocket maximums, by type of service.
- Other coverage the payer knows about, which feeds coordination of benefits.
- Flags that change who can be billed, such as QMB status.
Where it falls short
271s vary by payer. Some return only “active” with no benefit detail, some don’t list service types you need, and some payers don’t support the transaction well at all, so their benefits have to come from the portal. Coverage also changes, so one check at intake isn’t enough for a patient seen again months later.
Run your revenue cycle as workflows.
We are working with a small group of billing and operations teams to shape worklist. Tell us where your work gets stuck, and we'll show you how it would run.