What is the role of the Health Care Eligibility Benefit Inquiry and Response (270/271)?

The Health Care Eligibility Benefit Inquiry and Response (270/271) plays a crucial role in the healthcare reimbursement and eligibility verification processes. Its primary function is to facilitate inquiries about patient eligibility for benefits.

When a healthcare provider or practitioner needs to confirm whether a patient is eligible for specific health benefits, they can submit an inquiry (the 270 transaction). The response to this inquiry (the 271 transaction) then provides the necessary information regarding the patient's eligibility, including details about what services are covered, the effective dates of coverage, and any limitations or exclusions associated with the benefits.

This process is vital for ensuring that healthcare providers have accurate and timely information to make decisions regarding the services they can deliver to patients, as well as to streamline the claims process. By confirming eligibility prior to providing services, providers can reduce the risk of claim denials and improve the efficiency of billing operations.