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Billing Fundamentals/Intermediate/18 minutes/Reviewed 2026-07-10

Eligibility and Benefits: 270/271 Workflow

Use electronic eligibility as a point-in-time input while confirming plan, network, benefit, authorization, and COB details.

Quick answer

A 270 is an eligibility inquiry and a 271 is the response. The response can confirm useful coverage and benefit data, but it is not a guarantee that a specific claim will pay.

Rules to know

  • Verify the exact plan and date of service.
  • Check active status, benefit, network, copay, deductible, and authorization indicators.
  • Ask about other coverage and payer order.
  • Retain the response and reference but avoid promising payment.

Operational workflow

  1. 01Send the inquiry with accurate subscriber and provider data.
  2. 02Read the complete response, including plan and service-type details.
  3. 03Resolve mismatches before service.
  4. 04Confirm authorization and network rules separately when needed.
  5. 05Reverify when coverage, date, location, or service changes.

Common failure modes

  • Treating active coverage as service authorization.
  • Checking the wrong service type or plan.
  • Ignoring effective and termination dates.

Knowledge check

Does an active 271 response guarantee claim payment?

Official sources

Eligibility and Benefits TransactionCenters for Medicare & Medicaid ServicesReviewed 2026-07-10Adopted Standards and Operating RulesU.S. Department of Health and Human ServicesReviewed 2026-07-10

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Education only. Verify the current code set, payer contract, coverage policy, implementation guide, and claim-specific facts. Do not enter protected health information into this site.