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Eligibility & Benefits Standards and Operating Rules

The Health Care Eligibility Benefit Inquiry and Response and the associated X12 Technical Report Type 3 Implementation Guides provide the HIPAA-adopted standards for healthcare eligibility and benefit inquiries. These guides provide standardized data content for creation and use of the v5010 270/271 transaction. The 270 transaction set is used throughout the healthcare marketplace to transmit healthcare eligibility and benefit inquiries from health care providers, insurers, clearinghouses and other healthcare adjudication processors. Meanwhile, the 271 transaction set is the appropriate response mechanism for healthcare eligibility and benefit inquiries. The federally mandated CAQH CORE Eligibility & Benefits Operating Rules align with these transactions and help the industry more effectively implement and use the 270/271 transactions to determine a patient’s eligibility and benefits.

Tune in on July 11th for a new installment of an ongoing webinar series with the standard development organization, X12, and HHS-designated operating rule author, CAQH CORE.

What will you learn by registering for this webinar?

  • An overview of the X12N 270/271 standard transaction.
  • A review of the benefits of using the 270/271 transaction to communicate eligibility and benefits information, which saves providers both time and money.
  • An in-depth analysis of how the CAQH CORE Eligibility & Benefits Operating Rules work in concert with the 270/271 transaction to automate electronic eligibility and benefits inquiry processes and reduce the cost of today’s more manual processes more fully.

To view the other webinars in our educational series, please click here.


  • Donna Campbell, Provider Portal and Provider Connectivity Manager, BCBS Illinois
  • Evert Ford, Product Manager, Optum
  • Erin Weber, Vice President, CAQH CORE