Technical / EDI

The 270/271 Eligibility Transaction Explained

The 270 is an EDI eligibility and benefit inquiry sent to a payer; the 271 is the payer's response confirming coverage, plan details, co-pays, deductibles and benefits. Together they are how eligibility verification happens electronically, often in real time.

When software verifies a patient's insurance in seconds, it is usually running a 270/271 transaction. It is the EDI standard behind real-time eligibility, and knowing what it returns explains why some benefit details are precise and others are not.

The 270 inquiry

The 270 is a request sent to a payer asking whether a patient is covered and what their benefits are. It identifies the provider, the payer, the subscriber/patient, and the specific benefits or service types being asked about.

The 271 response

The 271 comes back with the answer: active or inactive coverage, plan and group details, co-pay, deductible and coinsurance amounts, and coverage for the requested service types. The level of detail depends on what the payer supports in their 271.

Real-time vs batch

270/271 can run in real time (a single patient, answer in seconds) or in batch (many patients at once, response returned later). Real-time is what powers point-of-service eligibility checks at scheduling and check-in.

Why automation matters here

Because 270/271 is a standard electronic exchange, it can be automated end to end: software sends the 270, reads the 271, validates coverage against the visit, and writes the result back, so every appointment gets checked instead of a sample.

How MedXFlow AI agents handle this

MedXFlow's AI agents work directly with the EDI transactions behind this - 270/271, 837, 835, 276/277 and 278 - and fall back to payer-portal automation where a transaction is not supported, so the workflow runs whatever channel each payer uses.

Related resources

• See MedXFlow Eligibility Verification
• Claims submission (837)
• Payment posting (835/ERA)