270 and 271 Explained: Eligibility Inquiry and Response
Last reviewed July 21, 2026 · Reviewed by the TurboVOB team
The 270 is the eligibility inquiry; the 271 is the payer's response. Both are X12 EDI transactions used for health care eligibility and benefits inquiry and response under HIPAA administrative simplification. As of 2026-07-21, CMS lists 270/271 among the mandated transaction standards; X12 maintains the transaction-set definitions.
What's in a 270
A 270 is the request. In practice it identifies who is asking (the provider or their agent), who the subscriber and patient are (member ID, name, date of birth), which payer should answer, and enough about the planned service — service type, date of service — for the payer to return a useful response. Wrong subscriber details are a common cause of a no-match that looks like a coverage problem but is not one.
What's in a 271
A 271 is the answer. At minimum you expect an active/inactive (or equivalent) coverage signal and plan identification. Beyond that, the 271 may carry copay, deductible, coinsurance, out-of-pocket maximum, and limitations — but those benefit segments are not uniformly populated. CAQH CORE operating rules aim to improve consistency of eligibility and benefits responses across the industry; even so, what any one payer returns for behavioral health still varies in practice.
Variability by payer is the honest point
What the 271 does not reliably tell you
For behavioral-health practices, three gaps show up often enough that they should be assumed until proven otherwise:
- Behavioral-health carve-outs — the medical payer on the card may not administer mental-health benefits. The 271 from the wrong company can look fine and still be the wrong answer.
- Prior authorization by code — many plans treat codes differently (for example, 90837 vs 90834). A single “outpatient mental health covered” signal does not answer per-code auth.
- Telehealth specifics — coverage, payment parity, place-of-service, and modifiers are often incomplete or absent on the electronic response.
Those gaps are why a phone call still exists as a method, and why a reference number still matters for appeals. The full procedure — carve-out first, right questions, record the reference — is in how to verify insurance eligibility and benefits.
From EDI to plain English
A raw 271 is segments and codes. Someone has to map that into answers a front desk can use: what the client owes today, whether this code needs prior auth, how many visits are left, whether telehealth is covered. That mapping is the useful part of verification software — not a promise that every plan returns every field, and not a substitute for reading the answer.
TurboVOB runs the eligibility check against the payer through a clearinghouse connection and returns the response as named fields: outpatient behavioral-health copay, deductible remaining, prior-auth flags by CPT code, visit limits, and telehealth coverage. You do not need your own clearinghouse account. We support major commercial payers; we do not support Medicare or Medicaid yet, and we do not have direct EHR integrations.
A verification reflects what the payer had on file at the time of the check. It is not a guarantee of payment. Coverage can change mid-year, and retroactive terminations happen. Keep your reference number.
For the category definition and hub, see insurance verification. For therapy-specific product detail, see behavioral health benefits verification.
Frequently asked questions
Is a 271 the same as verifying benefits?
No. A 271 is the payer's electronic eligibility and benefits response. It often confirms active coverage and may include plan and benefit detail, but the depth of that detail varies by payer. Behavioral-health copay, prior auth by code, visit limits, and telehealth rules frequently still require a portal dig or a phone call.
Can I read a 271 myself?
Yes, if you have a clearinghouse account and someone who can interpret X12 EDI segments. Most front-desk staff do not want to. Software exists so the same data returns as named fields rather than segment strings.
Do I need a clearinghouse account?
Not if you use software that connects on your behalf. TurboVOB connects to payers through a clearinghouse connection; you do not need your own clearinghouse account. If you run 270/271 transactions yourself, you do need an account and the setup that goes with it.
Does a 271 guarantee payment?
No. A verification reflects what the payer had on file at the time of the check. It is not a guarantee of payment. Coverage can change mid-year, and retroactive terminations happen. Keep documentation of what you received and when.
Sources
- [1] HIPAA Administrative Simplification — Health Care Eligibility Benefit Inquiry and Response (270/271) — CMS. Accessed 2026-07-21.
- [2] X12 transaction sets — 270/271 Eligibility, Coverage or Benefit Inquiry/Information — X12. Accessed 2026-07-21.
- [3] Eligibility (HETS 270/271) — CMS. Accessed 2026-07-21.
- [4] CAQH CORE Eligibility & Benefits operating rules — CAQH. Accessed 2026-07-21.
Related
Insurance verification
What verification means for providers — eligibility vs benefits, methods, hub.
How to verify insurance eligibility and benefits
The eight steps, from reading the card to recording the reference number.
Benefits verification built for therapy practices
Prior auth by code, visit limits, telehealth — the product view.
See it against your payer mix.
Twenty minutes. We'll run a live verification against the payers you actually bill.
TurboVOB acts as a business associate under HIPAA and signs a Business Associate Agreement with every customer that processes protected health information through the platform.