Eligibility check (270/271)
DefinitionAn electronic question to a payer (the 270) and its answer (the 271): is coverage active, and what are the member's benefits and cost share.
The 270/271 pair is the HIPAA standard for eligibility: your system sends a 270 inquiry and the payer returns a 271 response, usually in seconds (CMS: Eligibility Benefit Inquiry and Response). Health plans must also follow federally adopted operating rules for this transaction.
What a 271 usually answers well:
- Whether coverage is active on the date you asked about.
- Plan type and, often, copay, coinsurance and deductible status.
What it often doesn't answer for nutrition:
- MNT visit or unit limits, and how many are used.
- Whether nutrition counseling processes under the preventive or the medical benefit.
- Referral or prior authorization rules and diagnosis restrictions.
So the efficient workflow is electronic first, phone for the gaps: run the check at booking and before visits, then call about the nutrition-specific questions and log the rep's name and reference number.
Neither a 271 nor a phone quote guarantees payment; both are evidence of what the plan said on that date.