Eligibility and Status Transactions: 270/271 and 276/277

Supporting X12 Transactions: Eligibility (270/271) and Claim Status (276/277)#

Beyond the claim (837) and remittance (835), several other HIPAA-standard X12 transactions support the revenue cycle. Knowing the pair numbers is part of RCM fluency.

270 / 271 — Eligibility and Benefit Inquiry and Response.

• The 270 is the provider's *inquiry*: "Is this patient eligible, and what are their benefits?"
• The 271 is the payer's *response*: active/inactive coverage, plan, effective dates, copay/coinsurance/deductible, and sometimes whether services need prior authorization.
• Run at the front end (scheduling/registration), real-time 270/271 eligibility verification prevents wrong-payer denials (CARC 109), coverage-termination denials, and surprise patient balances.

276 / 277 — Claim Status Inquiry and Response.

• The 276 asks the payer, "What is the status of this claim I already submitted?"
• The 277 is the payer's status answer (accepted, pending, finalized, denied, etc.). There is also a 277CA (Claim Acknowledgment) used by payers/clearinghouses to acknowledge or reject a claim before adjudication.
• Automated 276/277 status checks let RCM teams follow up on aging claims without phone calls, catching stalled claims before they age out of timely-filing windows.

278 — Health Care Services Review (Prior Authorization).

• The electronic prior-authorization request/response transaction. Historically under-adopted, which is why much prior auth remains manual (see prior-authorization friction).

Together these transactions let a modern RCM platform verify coverage up front (270/271), submit clean claims (837), check status automatically (276/277), and post and analyze remittances (835) — an end-to-end electronic loop that minimizes manual touches.