X12 271 eligibility response: format and example

271 structure

The full X12 271 layout from its OpenEDI definition, the same model ediFabric uses to parse, validate and generate it: 16 loops and 69 segment positions, in file order. Loops are shaded and their segments indented; Max use is how many times a segment or loop may repeat.

Segment / loop	Name	Usage	Max use
`ST`	Transaction Set Header	Required	1
`BHT`	Beginning of Hierarchical Transaction	Required	1
Loop 2000A	Information Source Level	Required	>1
`HL`	Information Source Level	Required	1
`AAA`	Request Validation	Situational	9
Loop 2100A	Information Source Name	Required	1
`NM1`	Information Source Name	Required	1
`PER`	Information Source Contact Information	Situational	3
`AAA`	Request Validation	Situational	9
Loop 2000B	Information Receiver Level	Situational	>1
`HL`	Information Receiver Level	Required	1
Loop 2100B	Information Receiver Name	Required	1
`NM1`	Information Receiver Name	Required	1
`REF`	Information Receiver Additional Identification	Situational	9
`N3`	Information Receiver Address	Situational	1
`N4`	Information Receiver City State ZIP Code	Situational	1
`AAA`	Information Receiver Request Validation	Situational	9
`PRV`	Information Receiver Provider Information	Situational	1
Loop 2000C	Subscriber Level	Situational	>1
`HL`	Subscriber Level	Required	1
`TRN`	Subscriber Trace Number	Situational	3
Loop 2100C	Subscriber Name	Required	1
`NM1`	Subscriber Name	Required	1
`REF`	Subscriber Additional Identification	Situational	9
`N3`	Subscriber Address	Situational	1
`N4`	Subscriber City State ZIP Code	Situational	1
`AAA`	Subscriber Request Validation	Situational	9
`PRV`	Provider Information	Situational	1
`DMG`	Subscriber Demographic Information	Situational	1
`INS`	Subscriber Relationship	Situational	1
`HI`	Subscriber Health Care Diagnosis Code	Situational	1
`DTP`	Subscriber Date	Situational	9
`MPI`	Subscriber Military Personnel Information	Situational	1
Loop 2110C	Subscriber Eligibilityor Benefit Information	Situational	>1
`EB`	Subscriber Eligibilityor Benefit Information	Required	1
`HSD`	Health Care Services Delivery	Situational	9
`REF`	Subscriber Additional Identification	Situational	9
`DTP`	Subscriber Eligibility Benefit Date	Situational	20
`AAA`	Subscriber Request Validation	Situational	9
`MSG`	Message Text	Situational	10
Loop 2115C	Subscriber Eligibilityor Benefit Additional Information	Situational	10
`III`	Subscriber Eligibilityor Benefit Additional Information	Required	1
Loop LS	Header	Situational	1
`LS`	Header	Required	1
Loop 2120C	Subscriber Benefit Related Entity Name	Situational	23
`NM1`	Subscriber Benefit Related Entity Name	Required	1
`N3`	Subscriber Benefit Related Entity Address	Situational	1
`N4`	Subscriber Benefit Related Entity City State ZIP Code	Situational	1
`PER`	Subscriber Benefit Related Entity Contact Information	Situational	3
`PRV`	Subscriber Benefit Related Provider Information	Situational	1
`LE`	Trailer	Required	1
Loop 2000D	Dependent Level	Situational	>1
`HL`	Dependent Level	Required	1
`TRN`	Dependent Trace Number	Situational	3
Loop 2100D	Dependent Name	Required	1
`NM1`	Dependent Name	Required	1
`REF`	Dependent Additional Identification	Situational	9
`N3`	Dependent Address	Situational	1
`N4`	Dependent City State ZIP Code	Situational	1
`AAA`	Dependent Request Validation	Situational	9
`PRV`	Provider Information	Situational	1
`DMG`	Dependent Demographic Information	Situational	1
`INS`	Dependent Relationship	Situational	1
`HI`	Dependent Health Care Diagnosis Code	Situational	1
`DTP`	Dependent Date	Situational	9
`MPI`	Dependent Military Personnel Information	Situational	1
Loop 2110D	Dependent Eligibilityor Benefit Information	Situational	>1
`EB`	Dependent Eligibilityor Benefit Information	Required	1
`HSD`	Health Care Services Delivery	Situational	9
`REF`	Dependent Additional Identification	Situational	9
`DTP`	Dependent Eligibility Benefit Date	Situational	20
`AAA`	Dependent Request Validation	Situational	9
`MSG`	Message Text	Situational	10
Loop 2115D	Dependent Eligibilityor Benefit Additional Information	Situational	10
`III`	Dependent Eligibilityor Benefit Additional Information	Required	1
Loop LS	Header	Situational	1
`LS`	Header	Required	1
Loop 2120D	Dependent Benefit Related Entity Name	Situational	23
`NM1`	Dependent Benefit Related Entity Name	Required	1
`N3`	Dependent Benefit Related Entity Address	Situational	1
`N4`	Dependent Benefit Related Entity City State ZIP Code	Situational	1
`PER`	Dependent Benefit Related Entity Contact Information	Situational	3
`PRV`	Dependent Benefit Related Provider Information	Situational	1
`LE`	Trailer	Required	1
`SE`	Transaction Set Trailer	Required	1

Usage follows the 005010X279A1 implementation guide: Required segments must be sent, Situational ones only when the guide's condition applies. Trading partners often add their own rules in companion guides - ediFabric templates can be adjusted to match. Open the element-level definition in the EdiNation spec library.

Sample 271 file

An eligibility response with active coverage and benefit details. Paste it into EdiNation to see every element named and validated.

ISA*00*          *00*          *ZZ*1234567        *ZZ*11111          *170508*1141*>*00501*000000101*1*P*:~
GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X279A1~
ST*271*4321*005010X279A1~
BHT*0022*11*10001234*20060501*1319~
HL*1**20*1~
NM1*PR*2*ABC COMPANY*****PI*842610001~
HL*2*1*21*1~
NM1*1P*2*BONE AND JOINT CLINIC*****SV*2000035~
HL*3*2*22*0~
TRN*2*93175-012547*9877281234~
NM1*IL*1*SMITH*JOHN****MI*123456789~
N3*15197 BROADWAY AVENUE*APT 215~
N4*KANSAS CITY*MO*64108~
DMG*D8*19630519*M~
DTP*346*D8*20060101~
EB*1**30**GOLD 123 PLAN~
EB*L~
EB*1**1>33>35>47>86>88>98>AL>MH>UC~
EB*B**1>33>35>47>86>88>98>AL>MH>UC*HM*GOLD 123 PLAN*27*10*****Y~
EB*B**1>33>35>47>86>88>98>AL>MH>UC*HM*GOLD 123 PLAN*27*30*****N~
LS*2120~
NM1*P3*1*JONES*MARCUS****SV*0202034~
LE*2120~
SE*22*4321~
GE*1*101~
IEA*1*000000101~

The same 271 as JSON

ediFabric turns every loop, segment and element into a named field. This is the transaction from the sample, in the JSON that ediFabric Native and Cloud return and accept.

{
  "ST": {
    "TransactionSetIdentifierCode_01": "271",
    "TransactionSetControlNumber_02": "4321",
    "ImplementationConventionPreference_03": "005010X279A1"
  },
  "BHT_BeginningOfHierarchicalTransaction": {
    "HierarchicalStructureCode_01": "0022",
    "TransactionSetPurposeCode_02": "11",
    "SubmitterTransactionIdentifier_03": "10001234",
    "TransactionSetCreationDate_04": "20060501",
    "TransactionSetCreationTime_05": "1319"
  },
  "Loop2000A": [
    {
      "HL_InformationSourceLevel": {
        "HierarchicalIDNumber_01": "1",
        "HierarchicalLevelCode_03": "20",
        "HierarchicalChildCode_04": "1"
      },
      "Loop2100A": {
        "NM1_InformationSourceName": {
          "EntityIdentifierCode_01": "PR",
          "EntityTypeQualifier_02": "2",
          "ResponseContactLastorOrganizationName_03": "ABC COMPANY",
          "IdentificationCodeQualifier_08": "PI",
          "ResponseContactIdentifier_09": "842610001"
        }
      },
      "Loop2000B": [
        {
          "HL_InformationReceiverLevel": {
            "HierarchicalIDNumber_01": "2",
            "HierarchicalParentIDNumber_02": "1",
            "HierarchicalLevelCode_03": "21",
            "HierarchicalChildCode_04": "1"
          },
          "Loop2100B": {
            "NM1_InformationReceiverName": {
              "EntityIdentifierCode_01": "1P",
              "EntityTypeQualifier_02": "2",
              "ResponseContactLastorOrganizationName_03": "BONE AND JOINT CLINIC",
              "IdentificationCodeQualifier_08": "SV",
              "ResponseContactIdentifier_09": "2000035"
            }
          },
          "Loop2000C": [
            {
              "HL_SubscriberLevel": {
                "HierarchicalIDNumber_01": "3",
                "HierarchicalParentIDNumber_02": "2",
                "HierarchicalLevelCode_03": "22",
                "HierarchicalChildCode_04": "0"
              },
              "TRN_SubscriberTraceNumber": [
                {
                  "TraceTypeCode_01": "2",
                  "CurrentTransactionTraceNumber_02": "93175-012547",
                  "OriginatingCompanyIdentifier_03": "9877281234"
                }
              ],
              "Loop2100C": {
                "NM1_SubscriberName": {
                  "EntityIdentifierCode_01": "IL",
                  "EntityTypeQualifier_02": "1",
                  "ResponseContactLastorOrganizationName_03": "SMITH",
                  "ResponseContactFirstName_04": "JOHN",
                  "IdentificationCodeQualifier_08": "MI",
                  "ResponseContactIdentifier_09": "123456789"
                },
                "N3_SubscriberAddress": {
                  "ResponseContactAddressLine_01": "15197 BROADWAY AVENUE",
                  "ResponseContactAddressLine_02": "APT 215"
                },
                "N4_SubscriberCity_State_ZIPCode": {
                  "AdditionalPatientInformationContactCityName_01": "KANSAS CITY",
                  "AdditionalPatientInformationContactStateCode_02": "MO",
                  "AdditionalPatientInformationContactPostalZoneorZIPCode_03": "64108"
                },
                "DMG_SubscriberDemographicInformation": {
                  "DateTimePeriodFormatQualifier_01": "D8",
                  "DependentBirthDate_02": "19630519",
                  "DependentGenderCode_03": "M"
                },
                "DTP_SubscriberDate": [
                  {
                    "DateTimeQualifier_01": "346",
                    "DateTimePeriodFormatQualifier_02": "D8",
                    "DateTimePeriod_03": "20060101"
                  }
                ],
                "Loop2110C": [
                  {
                    "EB_SubscriberEligibilityorBenefitInformation": {
                      "EligibilityorBenefitInformation_01": "1",
                      "ServiceTypeCode_03": [
                        "30"
                      ],
                      "PlanCoverageDescription_05": "GOLD 123 PLAN"
                    }
                  },
                  {
                    "EB_SubscriberEligibilityorBenefitInformation": {
                      "EligibilityorBenefitInformation_01": "L"
                    }
                  },
                  {
                    "EB_SubscriberEligibilityorBenefitInformation": {
                      "EligibilityorBenefitInformation_01": "1",
                      "ServiceTypeCode_03": [
                        "1",
                        "33",
                        "35",
                        "47",
                        "86",
                        "88",
                        "98",
                        "AL",
                        "MH",
                        "UC"
                      ]
                    }
                  },
                  {
                    "EB_SubscriberEligibilityorBenefitInformation": {
                      "EligibilityorBenefitInformation_01": "B",
                      "ServiceTypeCode_03": [
                        "1",
                        "33",
                        "35",
                        "47",
                        "86",
                        "88",
                        "98",
                        "AL",
                        "MH",
                        "UC"
                      ],
                      "InsuranceTypeCode_04": "HM",
                      "PlanCoverageDescription_05": "GOLD 123 PLAN",
                      "TimePeriodQualifier_06": "27",
                      "BenefitAmount_07": "10",
                      "InPlanNetworkIndicator_12": "Y"
                    }
                  },
                  {
                    "EB_SubscriberEligibilityorBenefitInformation": {
                      "EligibilityorBenefitInformation_01": "B",
                      "ServiceTypeCode_03": [
                        "1",
                        "33",
                        "35",
                        "47",
                        "86",
                        "88",
                        "98",
                        "AL",
                        "MH",
                        "UC"
                      ],
                      "InsuranceTypeCode_04": "HM",
                      "PlanCoverageDescription_05": "GOLD 123 PLAN",
                      "TimePeriodQualifier_06": "27",
                      "BenefitAmount_07": "30",
                      "InPlanNetworkIndicator_12": "N"
                    },
                    "LoopLS": {
                      "LS_Header": {
                        "LoopIdentifierCode_01": "2120"
                      },
                      "Loop2120C": [
                        {
                          "NM1_SubscriberBenefitRelatedEntityName": {
                            "EntityIdentifierCode_01": "P3",
                            "EntityTypeQualifier_02": "1",
                            "ResponseContactLastorOrganizationName_03": "JONES",
                            "ResponseContactFirstName_04": "MARCUS",
                            "IdentificationCodeQualifier_08": "SV",
                            "ResponseContactIdentifier_09": "0202034"
                          }
                        }
                      ],
                      "LE_Trailer": {
                        "LoopIdentifierCode_01": "2120"
                      }
                    }
                  }
                ]
              }
            }
          ]
        }
      ]
    }
  ],
  "SE": {
    "NumberofIncludedSegments_01": "22",
    "TransactionSetControlNumber_02": "4321"
  }
}

Parse and validate a 271 file

Read the file into typed objects with ediFabric .NET, convert it to JSON in process with the ediFabric Native bindings for Python, Java and C, or post it to the ediFabric Cloud REST API from any language.

.NET
Python
Java
C
Cloud

using EdiFabric.Templates.Hipaa5010;

License.SetSerial("YOUR_SERIAL_KEY");

using (var stream = File.OpenRead(@"C:\edi\GenericResponse.txt"))
using (var reader = new X12Reader(stream, "EdiFabric.Templates.Hipaa"))
{
    var items = await reader.ReadToEndAsync();
    foreach (var transaction in items.OfType<TS271>())
    {
        if (transaction.IsValid(out MessageErrorContext errors))
            Console.WriteLine($"{transaction.ST.TransactionSetControlNumber_02} is valid");
        else
            Console.WriteLine(string.Join(Environment.NewLine, errors.Flatten()));
    }
} Install and get started 271 example project Walkthrough
import json
import edifabric_x12 as ef

serial = "YOUR_SERIAL_KEY"
ef.load_library()
ef.set_serial(serial)
ef.set_map(json.dumps({"default": serial, "maps": {}}))

edi = open("GenericResponse.txt", "rb").read()
output, offset = ef.parse(edi, ef.ParseMode.JSON_VALIDATE)
transactions = output[:offset]
report = json.loads(output[offset:])
print(report["errors_count"]) Python bindingsediFabric Native
import com.edifabric.nativex12.EdiFabricX12;
import com.edifabric.nativex12.ParseMode;
import com.edifabric.nativex12.ParseResult;

String serial = "YOUR_SERIAL_KEY";
EdiFabricX12.loadLibrary();
EdiFabricX12.setSerial(serial);
EdiFabricX12.setMap("{\"default\":\"" + serial + "\",\"maps\":{}}");

String edi = Files.readString(Path.of("GenericResponse.txt"));
ParseResult result = EdiFabricX12.parse(edi, ParseMode.JSON_VALIDATE);
System.out.println(result.getTransactions());
System.out.println(result.getReport()); Java bindingsediFabric Native
#include "edifabric_x12.h"

const char *serial = "YOUR_SERIAL_KEY";
ef_parse_result result;

if (ef_load_library(NULL) != 0)
    return 1;
ef_set_serial(serial);
ef_set_map("{\"default\":\"YOUR_SERIAL_KEY\",\"maps\":{}}");

char *edi = read_file("GenericResponse.txt", NULL);   /* helper in example_all_functions.c */
if (ef_parse(edi, EF_PARSE_JSON_VALIDATE, NULL, &result) == 0) {
    /* transactions = output[0 .. offset), report = output[offset .. length) */
    fwrite(result.output.data, 1, (size_t)result.output.length, stdout);
    ef_free(result.output.data);
} C bindingsediFabric Native
curl -X POST 'https://api.edination.com/v2/x12/read' \
-H 'Ocp-Apim-Subscription-Key: YOUR_SERIAL_KEY' \
-H 'Content-Type: application/octet-stream' \
--data-binary '@GenericResponse.txt' TranslateValidateediFabric Cloud

Generate a 271 file

Populate a TS271 object in .NET, or pass JSON in the shape shown above to ediFabric Native or ediFabric Cloud, and get a valid 271 file back.

.NET
Python
Java
C
Cloud

using EdiFabric.Templates.Hipaa5010;

License.SetSerial("YOUR_SERIAL_KEY");

var transaction = new TS271();

//  Transaction Set ID Code = 271 (Eligibility, Coverage or Benefit Information)
//  Transaction Set Control Number = 4321
//  Implementation Convention Reference = 005010X279A1
transaction.ST = new ST();
transaction.ST.TransactionSetIdentifierCode_01 = "271";
transaction.ST.TransactionSetControlNumber_02 = "0001";
transaction.ST.ImplementationConventionPreference_03 = "005010X279A1";

//  Hierarchical Structure Code = 0022 (Information Source, Information Receiver, Subscriber, Dependent)
//  Transaction Set Purpose Code = 11(Response) Identification
//  Reference Identification = 10001234
//  Date = 20060501(May 1, 2006)
//  Time = 1:19 PM
transaction.BHT_BeginningOfHierarchicalTransaction = new BHT_BeginningOfHierarchicalTransaction_2();
transaction.BHT_BeginningOfHierarchicalTransaction.HierarchicalStructureCode_01 = "0022";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetPurposeCode_02 = "11";
transaction.BHT_BeginningOfHierarchicalTransaction.SubmitterTransactionIdentifier_03 = "10001234";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationDate_04 = "20060501";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationTime_05 = "1319";

// ... set the remaining loops and segments the same way

// SegmentBuilders is in the Common project of the example repository
using (var stream = new MemoryStream())
{
    using (var writer = new X12Writer(stream))
    {
        writer.Write(SegmentBuilders.BuildIsa("1"));
        writer.Write(SegmentBuilders.BuildGs("1", "SENDER1", "RECEIVER1", "005010X279A1"));
        writer.Write(transaction);
    }
    Console.WriteLine(Encoding.UTF8.GetString(stream.ToArray()));
} Install and get started Full 271 build methodExample repository
import json
import edifabric_x12 as ef

serial = "YOUR_SERIAL_KEY"
ef.load_library()
ef.set_serial(serial)
ef.set_map(json.dumps({"default": serial, "maps": {}}))

# the transactions JSON returned by ef.parse, edited or produced by your application
transactions = open("GenericResponse.json", "rb").read()
edi = ef.build(transactions, postfix="\r\n")
print(edi) Python bindings
import com.edifabric.nativex12.EdiFabricX12;

String serial = "YOUR_SERIAL_KEY";
EdiFabricX12.loadLibrary();
EdiFabricX12.setSerial(serial);
EdiFabricX12.setMap("{\"default\":\"" + serial + "\",\"maps\":{}}");

// the transactions JSON returned by parse, edited or produced by your application
String transactions = Files.readString(Path.of("GenericResponse.json"));
String edi = EdiFabricX12.build(transactions, "\r\n");
System.out.println(edi); Java bindings
#include "edifabric_x12.h"

ef_buffer edi;

if (ef_load_library(NULL) != 0)
    return 1;
ef_set_serial("YOUR_SERIAL_KEY");
ef_set_map("{\"default\":\"YOUR_SERIAL_KEY\",\"maps\":{}}");

/* the transactions JSON returned by ef_parse, edited or produced by your application */
char *transactions = read_file("GenericResponse.json", NULL);
if (ef_build(transactions, "\r\n", &edi) == 0) {
    fwrite(edi.data, 1, (size_t)edi.length, stdout);
    ef_free(edi.data);
} C bindings
# the JSON returned by /read, edited or produced by your application
curl -X POST 'https://api.edination.com/v2/x12/write' \
-H 'Ocp-Apim-Subscription-Key: YOUR_SERIAL_KEY' \
-H 'Content-Type: application/json' \
--data-binary '@GenericResponse.json' \
-o 'GenericResponse.txt' How-tosediFabric Cloud

271 questions

How do I read an EB segment?

EB01 is the eligibility or benefit code (1 active coverage, 6 inactive, A co-insurance, B co-payment, C deductible), EB03 the service type code, EB06 the time period and EB07 or EB08 the amount or percent.

Is the 270/271 real time?

Mostly. Eligibility checks usually run as real-time request and response pairs, though batch 270/271 files are also supported.

What if the patient is not found?

The payer returns AAA segments with a reject reason, such as 72 invalid member ID or 75 subscriber not found, instead of EB segments.

How do I parse and generate X12 271 files in .NET, Python, Java and C?

In .NET, install EdiFabric and EdiFabric.Templates.Hipaa, read the file with X12Reader into TS271 objects and write them back with X12Writer. From Python, Java or C, use ediFabric Native, which converts 271 files to JSON and JSON back to X12 inside your process. From any other language, post the file to the ediFabric Cloud REST API.

Related transactions

X12 270 - Eligibility, Coverage or Benefit Inquiry
X12 278 - Health Care Services Review: Request for Review and Response
X12 834 - Benefit Enrollment and Maintenance
All EDI transactions →

X12 271 Eligibility, Coverage or Benefit Information

At a glance