Which HIPAA 5010 transaction is used to verify a patient's coverage before service?

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Multiple Choice

Which HIPAA 5010 transaction is used to verify a patient's coverage before service?

Verifying a patient’s coverage before service is done with the Eligibility transaction (270/271). The 270 asks the payer for the patient’s current eligibility and benefits, and the 271 returns the response with coverage status, effective dates, plan details, what the patient owes (co-pays, deductibles), and any prior authorization requirements. This pre-service check helps confirm the patient is covered and estimate financial responsibility, reducing the chance of claim denial later. Other transactions serve different timing: submitting a claim for payment after service (837), receiving the payer’s payment summary (835), or requesting pre-authorization for a service (278).

Verifying a patient’s coverage before service is done with the Eligibility transaction (270/271). The 270 asks the payer for the patient’s current eligibility and benefits, and the 271 returns the response with coverage status, effective dates, plan details, what the patient owes (co-pays, deductibles), and any prior authorization requirements. This pre-service check helps confirm the patient is covered and estimate financial responsibility, reducing the chance of claim denial later.

Other transactions serve different timing: submitting a claim for payment after service (837), receiving the payer’s payment summary (835), or requesting pre-authorization for a service (278).

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