271 Eligibility, Coverage or Benefit Information (004010X092A1)

Payers return the 271 in reply to a 270, with the patient's coverage, benefits, copays and deductibles. This is the standard X12 HIPAA 004010 spec, with 16 loops and 63 segment positions, as OpenEDI JSON, an ediFabric C# template and an ediFabric Native model. To change it for a trading partner, customize it in the EDI Spec Builder.

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The spec as an OpenAPI 3 schema with x-openedi-* extensions, for ediFabric Native, ediFabric Cloud and the EDI Spec Builder. Download OpenEDI (118 KB) Generate classes

The ediFabric .NET template, class TS271. The download includes the common segments, composites and codes it needs. Download C# (52 KB)

The intermediary model ediFabric Native loads with set_map. Download Native (56 KB)

Use the 271 spec in your code

ediFabric .NET

Add the C# template and its common files to your project, or reference the template NuGet package, and read 271 files into TS271 objects. See ediFabric .NET.

ediFabric Native

Map version 004010X092A1 to the Native model with set_map, then parse 271 files to JSON from Python, Java, C or C#. See Convert between EDI and JSON.

OpenEDI

Select Customize in Spec Builder to copy the spec under your own name, change it for your partner, and parse files against it in EdiNation, ediFabric Native or ediFabric Cloud. Read about OpenEDI.

Generate 271 classes in Python, Java, Node.js, Go, Rust or C

ediFabric Native returns each 271 as JSON, with the property names of the OpenEDI schema. To work with that JSON as typed objects, generate classes from the OpenEDI file in your language and deserialize the JSON into TS271. Serialize the objects back to JSON to build EDI with ediFabric Native. The classes keep the loops, segments, lengths and code lists, but not the EDI data formats, so validate files with ediFabric Native. Read more in Generate a class from OpenEDI.

Python: datamodel-code-generator. Node.js: openapi-typescript. Java, Go, Rust and C: OpenAPI Generator.

For a sample file, the same data as JSON, and code to parse, validate and generate the 271, see the 271 transaction guide.

271 structure

Loops and segments of the standard 271, with their usage and maximum repeats.

ID	Name	Usage	Max use
ST	Transaction Set Header	Optional	1
BHT	Beginning Of Hierarchical Transaction	Mandatory	1
Loop HL	Information Source Level	Mandatory	>1
HL	Information Source Level	Mandatory	1
AAA	Request Validation	Optional	9
Loop NM1	Information Source Name	Mandatory	1
NM1	Information Source Name	Mandatory	1
REF	Information Source Additional Identification	Optional	9
PER	Information Source Contact Information	Optional	3
AAA	Request Validation	Optional	9
Loop HL	Information Receiver Level	Optional	>1
HL	Information Receiver Level	Mandatory	1
Loop NM1	Information Receiver Name	Mandatory	1
NM1	Information Receiver Name	Mandatory	1
REF	Information Receiver Additional Identification	Optional	9
AAA	Information Receiver Request Validation	Optional	9
Loop HL	Subscriber Level	Optional	>1
HL	Subscriber Level	Mandatory	1
TRN	Subscriber Trace Number	Optional	3
Loop NM1	Subscriber Name	Mandatory	1
NM1	Subscriber Name	Mandatory	1
REF	Subscriber Additional Identification	Optional	9
N3	Subscriber Address	Optional	1
N4	Subscriber City State ZIP Code	Optional	1
PER	Subscriber Contact Information	Optional	3
AAA	Subscriber Request Validation	Optional	9
DMG	Subscriber Demographic Information	Optional	1
INS	Subscriber Relationship	Optional	1
DTP	Subscriber Date	Optional	9
Loop EB	Subscriber Eligibility Or Benefit Information	Optional	>1
EB	Subscriber Eligibility Or Benefit Information	Mandatory	1
HSD	Health Care Services Delivery	Optional	9
REF	Subscriber Additional Identification	Optional	9
DTP	Subscriber Eligibility Benefit Date	Optional	20
AAA	Subscriber Request Validation	Optional	9
MSG	Message Text	Optional	10
Loop III	Subscriber Eligibility Or Benefit Additional Information	Optional	10
III	Subscriber Eligibility Or Benefit Additional Information	Mandatory	1
Loop LS	Header	Optional	1
LS	Header	Mandatory	1
Loop NM1	Subscriber Benefit Related Entity Name	Optional	1
NM1	Subscriber Benefit Related Entity Name	Mandatory	1
N3	Subscriber Benefit Related Entity Address	Optional	1
N4	Subscriber Benefit Related City State ZIP Code	Optional	1
PER	Subscriber Benefit Related Entity Contact Information	Optional	3
PRV	Subscriber Benefit Related Provider Information	Optional	1
LE	Trailer	Mandatory	1
Loop HL	Dependent Level	Optional	>1
HL	Dependent Level	Mandatory	1
TRN	Dependent Trace Number	Optional	3
Loop NM1	Dependent Name	Mandatory	1
NM1	Dependent Name	Mandatory	1
REF	Dependent Additional Identification	Optional	9
N3	Dependent Address	Optional	1
N4	Dependent City State ZIP Code	Optional	1
PER	Dependent Contact Information	Optional	3
AAA	Dependent Request Validation	Optional	9
DMG	Dependent Demographic Information	Optional	1
INS	Dependent Relationship	Optional	1
DTP	Dependent Date	Optional	9
Loop EB	Dependent Eligibility Or Benefit Information	Optional	>1
EB	Dependent Eligibility Or Benefit Information	Mandatory	1
HSD	Health Care Services Delivery	Optional	9
REF	Dependent Additional Identification	Optional	9
DTP	Dependent Eligibility Benefit Date	Optional	20
AAA	Dependent Request Validation	Optional	9
MSG	Message Text	Optional	10
Loop III	Dependent Eligibility Or Benefit Additional Information	Optional	10
III	Dependent Eligibility Or Benefit Additional Information	Mandatory	1
Loop LS	Dependent Eligibility Or Benefit Information	Optional	1
LS	Dependent Eligibility Or Benefit Information	Mandatory	1
Loop NM1	Dependent Benefit Related Entity Name	Optional	1
NM1	Dependent Benefit Related Entity Name	Mandatory	1
N3	Dependent Benefit Related Entity Address	Optional	1
N4	Dependent Benefit Related Entity City State ZIP Code	Optional	1
PER	Dependent Benefit Related Entity Contact Information	Optional	3
PRV	Dependent Benefit Related Provider Information	Optional	1
LE	Trailer	Mandatory	1
SE	Transaction Set Trailer	Optional	1