EDI 270/271: Eligibility and Benefit Inquiry and Response
The EDI 270/271 pair is the X12 eligibility transaction. The 270 is the provider's inquiry asking a payer whether a patient is covered and what benefits apply; the 271 is the payer's response reporting active/inactive status, plan details, copays, deductibles, and coverage limits. It is the electronic backbone of real-time eligibility verification.
- Transaction
- 270 (inquiry) / 271 (response)
- Direction
- 270 outbound, 271 inbound
- Pairs with
- Each other; precedes the 837
What is the EDI 270/271?
The 270/271 is the eligibility check, done electronically. The 270 asks a payer "is this patient covered, and what are the benefits?" and the 271 answers with active/inactive status, plan and group details, and cost-share information. When your front desk clicks "verify eligibility" and gets a result in a second or two, a 270 went out and a 271 came back.
It runs before the claim — a clean 271 up front is what keeps the later 837 from denying for coverage problems.
What does the 271 return?
- Coverage status — active or inactive for the date checked.
- Plan and group — the specific product and the correct payer to bill.
- Cost-share — copay, coinsurance, and deductible remaining.
- Service-type benefits — often broken out by benefit category, with limits where provided.
- Other coverage — hints of coordination of benefits when a patient has more than one plan.
How is it used on the front end?
Real-time 270/271 at scheduling and check-in is the single highest-leverage denial-prevention step. It catches terminated coverage, wrong payer, and COB before a claim ever goes out, and it tells the front desk the correct copay to collect. Batch 270 runs the night before a clinic day flag problems while there is still time to fix them.
What should you watch when reading a 271?
Frequently asked questions
It is the eligibility and benefit transaction pair. The provider sends a 270 asking whether a patient has active coverage and what benefits apply for a service type; the payer returns a 271 with the answer — coverage status, plan and group, copay, coinsurance, deductible remaining, and often service-specific limits. It powers the real-time eligibility checks in most PM and EHR systems.
Because eligibility problems are the cheapest denials to prevent and the most expensive to work after the fact. Verifying active coverage, the correct payer, and the patient's cost-share up front prevents claims sent to a terminated plan, catches coordination-of-benefits situations, and lets you collect the right copay at check-in instead of chasing it later.
A 271 confirms coverage and benefits, but it is not a guarantee of payment and does not replace prior authorization or medical-necessity review. Benefit data can be general rather than procedure-specific, and a 271 showing "active" coverage does not mean a particular service is covered. Always pair eligibility with authorization (the 278) and payer medical policy.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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