Standards & EDI
270/271 (Eligibility Inquiry and Response)
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (Original definitions; regulatory facts to be verified against CMS-0057-F (89 FR 8758) and X12/HL7 documentation). Do not rely on it for production configuration until this notice is removed.
In more depth
The 271 can also indicate whether a benefit requires certification, making eligibility checks a lightweight first pass at "does this need prior auth?" The service type code list (element 1365) is shared between the 270/271 and the 278's UM03, which is why the same codes appear in both contexts.