270/271 Eligibility Inquiry/Response
The HIPAA standard EDI transactions used to verify patient insurance eligibility (270 query, 271 response).
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Payer
- Primary sources
- 1
- Workspace handoff
- revenue audit →
Where this comes up
Front-office and billing both hit this term — eligibility before the visit, prior auth before the procedure, contract terms during fee-schedule negotiation, and credentialing whenever a new provider joins or a payer roster lapses. Misses here become denials downstream.
Full definition
What it is in practice
CMS HIPAA Administrative Simplification requires payers to support 270/271. Most eligibility tools in EHR / practice management systems automate the exchange.
How it shows up in your practice
Run eligibility 24-72 hours before each appointment. Catch coverage termination, MSP, and deductible status before the visit.
Sources
- CMS — HIPAA Administrative Simplificationhttps://www.cms.gov/regulations-and-guidance/administrative-simplification
Audit eligibility-check workflow in Revenue Audit
Open revenue audit →Related terms
- PayerCoordination of Benefits (COB)The rules and processes that determine which of two or more insurance plans pays first when a patient is covered by multiple plans.
- Denials & AppealsMedicare Secondary Payer (MSP)Statutory rules at 42 USC 1395y(b) requiring other insurance to pay before Medicare in defined situations.
- PayerGood Faith Estimate (GFE)Under the No Surprises Act, the written estimate of expected charges providers must give to uninsured and self-pay patients prior to scheduled services.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryCoordination of Benefits (COB)The rules and processes that determine which of two or more insurance plans pays first when a patient is covered by multiple plans.
- GlossaryGood Faith Estimate (GFE)Under the No Surprises Act, the written estimate of expected charges providers must give to uninsured and self-pay patients prior to scheduled services.
- GlossaryMedicare Secondary Payer (MSP)Statutory rules at 42 USC 1395y(b) requiring other insurance to pay before Medicare in defined situations.
- Glossary835 Electronic Remittance Advice (ERA)The HIPAA-mandated electronic transaction by which payers communicate payment and adjustment information to providers.
- Glossary837 Electronic ClaimThe HIPAA-mandated electronic transaction for submitting professional (837P), institutional (837I), or dental (837D) claims.
- GlossaryClearinghouseAn entity that translates electronic transactions between providers and payers and applies front-end edits to reduce rejected claims.
- GlossaryEFT (Electronic Funds Transfer)The HIPAA-mandated electronic payment transaction that moves funds from payer to provider, paired with the 835 remittance.
- ComplianceOIG LEIE Monthly Exclusion Screening: Process + Audit-Ready LogsMonthly OIG LEIE and SAM.gov exclusion screening for every workforce member and vendor: the workflow, the log fields auditors require, and the escalation path.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.