A 271 eligibility response is the X12 EDI transaction a payer returns to answer a 270 eligibility inquiry, confirming whether a patient is covered and reporting the specifics of their benefits.
What it means
The 270 and 271 are a paired transaction set. A provider sends a 270 asking whether a given patient has active coverage, and the payer returns a 271 with the answer. The 271 reports the patient's plan status, effective dates, and benefit detail such as copay, coinsurance, deductible amounts and how much of the deductible remains, and which services are covered or require prior authorization.
The 271 happens before a claim is ever submitted. It does not guarantee payment, because final payment depends on adjudication of the actual 837 claim, but it confirms the coverage the claim will be billed against and flags benefit limits that could reduce the expected reimbursement.
A clear 271 lets a practice verify coverage at or before the visit, so the claim it later files rests on confirmed eligibility rather than an assumption.
Why it matters for your practice
Eligibility errors are one of the most common reasons claims are denied, and a 271 catches them up front: a terminated plan, a wrong member ID, or a service the policy does not cover. Verifying through the 271 before the visit means fewer denials weeks later and fewer claims stuck in your accounts receivable.
How this relates to Copay
The 271 is part of the verification infrastructure behind Copay's purchase decisions. Confirmed coverage from the 271, alongside the 277CA and the 835, is one of the signals that lets Copay identify which eligible claims to purchase and fund the next business day.
See how Copay works.
Written by Eitan Glick, CEO, Copay Inc.
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