The full definition
ASC X12 270/271 is the standardized electronic transaction for insurance eligibility inquiry. A provider sends a 270 request containing the patient's member ID, date of birth, and the date of service. The payer returns a 271 response with active/inactive status, copay, deductible status, coverage limitations, plan-specific benefits, and any preauthorization requirements. The whole round trip completes in seconds.
Why it matters in practice
Real-time eligibility verification has become operationally critical: practices that confirm coverage before the appointment have fewer denied claims, fewer surprise patient balances, and cleaner cash flow. The 270/271 standard is what powers it — every modern billing platform supports it.
Real-world examples
- Verifying BlueCross PPO coverage and copay before scheduling a new patient
- Confirming PT visits remaining for a returning patient
- Checking whether a patient's Medicaid plan covers a specific behavioral health code
Inside Velant
Velant's billing module runs 270/271 eligibility checks at $0.10 per check across all major commercial, Medicare, Medicare Advantage, and Medicaid payers.
Related terms
- 837P Electronic Claim SubmissionThe HIPAA-standard electronic claim format for professional services (physician, behavioral health, outpatient) — the most common claim type for non-hospital providers.
- ERA / 835 Electronic Remittance AdviceThe HIPAA-standard electronic format used by payers to communicate claim adjudication results — payments, denials, adjustments, and patient responsibility.
- HIPAA-Compliant CRMA customer relationship management system designed to handle Protected Health Information (PHI) in accordance with the Health Insurance Portability and Accountability Act of 1996.