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IMS Health
Standard Companion Guide
Health Care Eligibility/Benefit Inquiry
and Information Response (270/271)
Refers to the Implementation Guides Based on
ASC X12N Version 005010×279A1December 2019
DRAFT
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How to fill out health care eligibilitybenefit inquiry

How to fill out health care eligibilitybenefit inquiry
01
To fill out a health care eligibility benefit inquiry, follow these steps:
02
Gather all necessary information such as the patient's personal details, insurance information, and medical history.
03
Start by providing the patient's full name, date of birth, and contact information.
04
Proceed to enter the insurance information including the name of the insurance provider, policy number, and group number.
05
Include any additional details about the insurance coverage such as deductibles, co-payments, and maximum out-of-pocket expenses.
06
Provide a brief summary of the patient's medical history and current health condition.
07
Specify the reason for the health care eligibility inquiry, whether it's for a specific treatment, procedure, or general coverage enquiry.
08
Double-check all the entered information for accuracy and completeness.
09
Submit the filled-out health care eligibility benefit inquiry form to the appropriate organization or insurance company.
10
Keep a copy of the submitted form for your records.
11
Wait for a response from the organization or insurance company regarding the patient's eligibility and benefits.
Who needs health care eligibilitybenefit inquiry?
01
Health care eligibility benefit inquiry is needed by individuals who are seeking to determine their eligibility for health care services and benefits.
02
This includes patients who may require specific medical treatments, procedures, or medications and need to know if they are covered by their insurance.
03
Additionally, individuals who are considering changing their insurance plans or exploring different coverage options may also need to fill out a health care eligibility benefit inquiry to assess their potential benefits.
04
Health care providers and medical billing personnel may also need to submit a health care eligibility benefit inquiry on behalf of their patients.
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What is health care eligibility benefit inquiry?
Health care eligibility benefit inquiry is the process of checking a patient's eligibility for health care benefits and services before treatment or services are provided.
Who is required to file health care eligibility benefit inquiry?
Typically, health care providers or facilities that seek reimbursement for services rendered are required to file health care eligibility benefit inquiries.
How to fill out health care eligibility benefit inquiry?
To fill out a health care eligibility benefit inquiry, one must provide detailed patient information including demographics, insurance details, and specific services being inquired about.
What is the purpose of health care eligibility benefit inquiry?
The purpose of health care eligibility benefit inquiry is to ensure that patients are covered for specific health care services, to streamline billing processes, and to avoid claim denials.
What information must be reported on health care eligibility benefit inquiry?
Information that must be reported includes the patient's full name, date of birth, insurance policy number, the specific services requested, and the provider's information.
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