EDI 271 Eligibility Benefit Response — Data Dictionary

This page explains the current 369-column Smart Mapping schema for supported X12 EDI 271 files.

It is the converter's current projection, not exhaustive X279A1 support. There is no separate 271 Key schema.

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CSV/Excel mapping of all 369 output columns and their EDI 271 sources. No PHI.

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Column Definitions

Applies to the Client-Side EDI 271 eligibility-benefit response layout
ColumnEDI SourceDescription
File Name N/A (converter) Name of the input 271 EDI file. Useful when processing responses from multiple files.
ID N/A (converter) Stable row identifier assigned by the converter. This is not an EDI-native value.
Transaction Type ST01 / ST03 (normalized) Normalized transaction type. Use 271 when ST01 is 271 and the implementation reference identifies 005010X279A1.
Record Type N/A (converter; derived from EB/AAA loop) Identifies the row as Subscriber Benefit, Dependent Benefit, Information Source Rejection, Information Receiver Rejection, Subscriber Rejection, Dependent Rejection, Subscriber Benefit Rejection, or Dependent Benefit Rejection.
Response Detail Number N/A (converter) Sequential EB or AAA response-detail occurrence number within the ST/SE transaction.
Patient Response Detail Number N/A (converter) Sequential EB or patient-level AAA occurrence number within the active subscriber or dependent patient context.
Response Level N/A (converter; derived from loop) Human-readable response level: Information Source, Information Receiver, Subscriber, Dependent, Subscriber Benefit, or Dependent Benefit.
Response Source Loop 2100A/2100B/2100C/2100D/2110C/2110D X12 loop containing the EB or AAA segment represented by this row.
Patient Type N/A (converter; derived from hierarchy) Indicates whether the patient associated with this response detail is the subscriber, a dependent, or unavailable for a higher-level rejection.
Response Result EB01 or AAA03/AAA04 (derived) Human-readable response result derived from the eligibility or benefit information code or request-validation rejection.
Benefit Category EB01 (derived) Normalized benefit category such as Active Coverage, Inactive Coverage, Copayment, Coinsurance, Deductible, Limitation, Primary Care Provider, or Other Benefit.
Rejection Indicator AAA presence (derived) Yes when this row represents an AAA request-validation rejection; otherwise No.
Network Status EB12 (derived) Human-readable in-network, out-of-network, unknown, or not-specified status for the benefit row.
Response Summary EB/HSD/REF/DTP/MSG/AAA/2120 (derived) Concise human-readable summary of the benefit detail or request-validation rejection without exposing unnecessary identifiers.
Current Hierarchical ID Active response HL01 Hierarchical ID number for the hierarchy level associated with this response detail.
Parent Hierarchical ID Active response HL02 Hierarchical parent ID number for the hierarchy level associated with this response detail.
Hierarchical Level Code Active response HL03 Code identifying the current hierarchy level, normally 20, 21, 22, or 23.
Hierarchical Child Code Active response HL04 Indicates whether subordinate HL loops follow beneath the current hierarchy level.
Information Source Hierarchical ID 2000A HL01 Hierarchical ID number for the information source level.
Information Receiver Hierarchical ID 2000B HL01 Hierarchical ID number for the information receiver level.
Subscriber Hierarchical ID 2000C HL01 Hierarchical ID number for the subscriber level associated with the response detail.
Dependent Hierarchical ID 2000D HL01 Hierarchical ID number for the dependent level when the patient is a dependent.
271 Transaction Control Number ST02 Transaction set control number assigned to the 271 response.
271 Implementation Reference ST03 Implementation convention/version identifier. Smart Mapping supports exact 005010X279A1; blank ST03 may use exact GS08 005010X279A1 as fallback.
Hierarchical Structure Code BHT01 Code identifying the hierarchy used by the eligibility response, commonly 0022.
Transaction Set Purpose Code BHT02 Purpose of the transaction set. A 271 response normally uses code 11 for Response.
271 Reference Identification BHT03 Application-level reference identifier used to correlate the 271 with the originating eligibility inquiry.
271 Creation Date BHT04 Date the 271 response was created in the sender's business application.
271 Creation Time BHT05 Time the 271 response was created in the sender's business application.
271 Transaction Type Code BHT06 Transaction type code supplied in BHT06 when present.
Functional Identifier Code GS01 Functional identifier code for the group containing the 271, normally HS.
Functional Group Sender Code GS02 Application sender code for the functional group containing the 271.
Functional Group Receiver Code GS03 Application receiver code for the functional group containing the 271.
Functional Group Creation Date GS04 Date the functional group containing the 271 was created.
Functional Group Creation Time GS05 Time the functional group containing the 271 was created.
271 Group Control Number GS06 Functional-group control number of the group containing the 271.
Responsible Agency Code GS07 Code identifying the standards organization responsible for the implementation guide, normally X.
271 Group Version GS08 Version, release, and implementation-guide identifier of the functional group containing the 271.
Interchange Sender Qualifier ISA05 Qualifier identifying the type of interchange sender identifier used in ISA06.
Interchange Sender ID ISA06 Interchange sender identifier. Fixed-width ISA padding should be trimmed for display and export.
Interchange Receiver Qualifier ISA07 Qualifier identifying the type of interchange receiver identifier used in ISA08.
Interchange Receiver ID ISA08 Interchange receiver identifier. Fixed-width ISA padding should be trimmed for display and export.
Interchange Date ISA09 Date the interchange containing the 271 was created.
Interchange Time ISA10 Time the interchange containing the 271 was created.
Repetition Separator ISA11 Repetition separator defined by the interchange, including repeated EB03 service type codes.
Interchange Control Version ISA12 Interchange control version number.
Interchange Control Number ISA13 Interchange control number assigned to the interchange containing the 271.
Acknowledgment Requested ISA14 Indicates whether an interchange acknowledgment is requested.
Interchange Usage Indicator ISA15 Indicates whether the interchange is production, test, or information.
Component Element Separator ISA16 Component element separator defined by the interchange.
Information Source Entity Code 2100A NM101 Entity Identifier Code for the information source, normally PR for payer.
Information Source Entity Description 2100A NM101 code translation Human-readable description of the information source entity code.
Information Source Entity Type 2100A NM102 Entity type qualifier indicating whether the information source is a person or organization.
Information Source Name 2100A NM103 Organization or last name of the payer or other information source returning the response.
Information Source First Name 2100A NM104 First name of the information source when the entity is an individual.
Information Source Middle Name 2100A NM105 Middle name or initial of the information source when supplied.
Information Source Name Prefix 2100A NM106 Name prefix of the information source when supplied.
Information Source Name Suffix 2100A NM107 Name suffix of the information source when supplied.
Information Source ID Qualifier 2100A NM108 Qualifier identifying the information source identifier in NM109, commonly PI.
Information Source ID 2100A NM109 Identifier of the payer or other information source returning the response.
Information Source Additional Identifiers 2100A REF segments All information-source REF qualifier and identifier pairs preserved in source order.
Information Source Address Line 1 2100A N301 First address line of the information source when supplied.
Information Source Address Line 2 2100A N302 Second address line of the information source when supplied.
Information Source City 2100A N401 City of the information source address.
Information Source State 2100A N402 State or province code of the information source address.
Information Source Postal Code 2100A N403 Postal code of the information source address.
Information Source Country Code 2100A N404 Country code of the information source address when supplied.
Information Source Location Qualifier 2100A N405 Qualifier identifying the location identifier in N406.
Information Source Location ID 2100A N406 Location identifier associated with the qualifier in N405.
Information Source Country Subdivision 2100A N407 Country subdivision code when supplied.
Information Source Provider Code 2100A PRV01 Provider role or type code when PRV is supplied in information-source context.
Information Source Provider ID Qualifier 2100A PRV02 Qualifier identifying the provider specialty or taxonomy value in PRV03.
Information Source Provider Specialty ID 2100A PRV03 Provider specialty or taxonomy identifier supplied in information-source context.
Information Source Provider State 2100A PRV04 Provider state or province value when supplied.
Other Information Source Provider Data Other 2100A PRV elements/occurrences Supported additional information-source PRV values serialized in source order within the current schema boundary.
Information Source Contact Function Code 2100A PER01 Code identifying the function of the information-source contact.
Information Source Contact Function Description 2100A PER01 code translation Human-readable description of the information-source contact function.
Information Source Contact Name 2100A PER02 Name of the information-source contact.
Information Source Communication Qualifier 1 2100A PER03 Qualifier identifying the first communication number in PER04.
Information Source Communication Description 1 2100A PER03 code translation Human-readable description of the first communication qualifier.
Information Source Communication Number 1 2100A PER04 First information-source contact number or address.
Information Source Communication Qualifier 2 2100A PER05 Qualifier identifying the second communication number in PER06.
Information Source Communication Description 2 2100A PER05 code translation Human-readable description of the second communication qualifier.
Information Source Communication Number 2 2100A PER06 Second information-source contact number or address.
Information Source Communication Qualifier 3 2100A PER07 Qualifier identifying the third communication number in PER08.
Information Source Communication Description 3 2100A PER07 code translation Human-readable description of the third communication qualifier.
Information Source Communication Number 3 2100A PER08 Third information-source contact number or address.
Other Information Source Contacts Additional 2100A PER segments Additional information-source contacts preserved in source order.
Information Receiver Entity Code 2100B NM101 Entity Identifier Code for the information receiver, such as provider, hospital, or facility.
Information Receiver Entity Description 2100B NM101 code translation Human-readable description of the information receiver entity code.
Information Receiver Entity Type 2100B NM102 Entity type qualifier indicating whether the information receiver is a person or organization.
Information Receiver Name 2100B NM103 Organization or last name of the provider or other information receiver.
Information Receiver First Name 2100B NM104 First name of the information receiver when the entity is an individual.
Information Receiver Middle Name 2100B NM105 Middle name or initial of the information receiver when supplied.
Information Receiver Name Prefix 2100B NM106 Name prefix of the information receiver when supplied.
Information Receiver Name Suffix 2100B NM107 Name suffix of the information receiver when supplied.
Information Receiver ID Qualifier 2100B NM108 Qualifier identifying the information receiver identifier in NM109.
Information Receiver ID 2100B NM109 Primary identifier of the provider or information receiver.
Information Receiver NPI 2100B NM109 where NM108=XX (derived) National Provider Identifier when the information receiver identifier qualifier is XX.
Information Receiver Service Provider Number 2100B NM109 where NM108=SV (derived) Service provider number when the information receiver identifier qualifier is SV.
Information Receiver Tax ID 2100B NM109 where NM108=FI (derived) Federal tax identifier when the information receiver identifier qualifier is FI.
Information Receiver Additional Identifiers 2100B REF segments All information-receiver REF qualifier and identifier pairs preserved in source order.
Information Receiver Address Line 1 2100B N301 First address line of the information receiver.
Information Receiver Address Line 2 2100B N302 Second address line of the information receiver when supplied.
Information Receiver City 2100B N401 City of the information receiver address.
Information Receiver State 2100B N402 State or province code of the information receiver address.
Information Receiver Postal Code 2100B N403 Postal code of the information receiver address.
Information Receiver Country Code 2100B N404 Country code of the information receiver address when supplied.
Information Receiver Location Qualifier 2100B N405 Qualifier identifying the location identifier in N406.
Information Receiver Location ID 2100B N406 Location identifier associated with the qualifier in N405.
Information Receiver Country Subdivision 2100B N407 Country subdivision code when supplied.
Information Receiver Provider Code 2100B PRV01 Code identifying the information receiver's provider role or type.
Information Receiver Provider ID Qualifier 2100B PRV02 Qualifier identifying the provider specialty or taxonomy value in PRV03.
Information Receiver Provider Specialty ID 2100B PRV03 Provider specialty or taxonomy identifier supplied for the information receiver.
Information Receiver Provider State 2100B PRV04 Provider state or province value when supplied.
Other Information Receiver Provider Data Other 2100B PRV elements/occurrences Supported additional information-receiver PRV values serialized in source order within the current schema boundary.
Information Receiver Contact Function Code 2100B PER01 Code identifying the function of the information-receiver contact.
Information Receiver Contact Function Description 2100B PER01 code translation Human-readable description of the information-receiver contact function.
Information Receiver Contact Name 2100B PER02 Name of the information-receiver contact.
Information Receiver Communication Qualifier 1 2100B PER03 Qualifier identifying the first communication number in PER04.
Information Receiver Communication Description 1 2100B PER03 code translation Human-readable description of the first communication qualifier.
Information Receiver Communication Number 1 2100B PER04 First information-receiver contact number or address.
Information Receiver Communication Qualifier 2 2100B PER05 Qualifier identifying the second communication number in PER06.
Information Receiver Communication Description 2 2100B PER05 code translation Human-readable description of the second communication qualifier.
Information Receiver Communication Number 2 2100B PER06 Second information-receiver contact number or address.
Information Receiver Communication Qualifier 3 2100B PER07 Qualifier identifying the third communication number in PER08.
Information Receiver Communication Description 3 2100B PER07 code translation Human-readable description of the third communication qualifier.
Information Receiver Communication Number 3 2100B PER08 Third information-receiver contact number or address.
Other Information Receiver Contacts Additional 2100B PER segments Additional information-receiver contacts preserved in source order.
Subscriber Trace Type Code 2000C TRN01 Trace type code returned for the subscriber inquiry.
Subscriber Trace Number 2000C TRN02 Reference identifier returned for matching the 271 response to the original subscriber inquiry.
Subscriber Originating Company Identifier 2000C TRN03 Originating company identifier from the subscriber-level trace segment.
Subscriber Trace Reference Identifier 2000C TRN04 Additional subscriber-level trace reference when supplied.
Subscriber Entity Code 2100C NM101 Entity Identifier Code for the subscriber, normally IL.
Subscriber Entity Description 2100C NM101 code translation Human-readable description of the subscriber entity code.
Subscriber Entity Type 2100C NM102 Entity type qualifier for the subscriber.
Subscriber Last Name 2100C NM103 Subscriber last name or organization name.
Subscriber First Name 2100C NM104 Subscriber first name.
Subscriber Middle Name 2100C NM105 Subscriber middle name or initial when supplied.
Subscriber Name Prefix 2100C NM106 Subscriber name prefix when supplied.
Subscriber Name Suffix 2100C NM107 Subscriber name suffix when supplied.
Subscriber ID Qualifier 2100C NM108 Qualifier identifying the subscriber identifier in NM109, commonly MI.
Subscriber Member ID 2100C NM109 Subscriber member or policy identifier returned by the information source.
Subscriber Group/Policy Number 2100C REF02 where REF01=1L Subscriber group or policy number when supplied with REF qualifier 1L.
Subscriber Plan Number 2100C REF02 where REF01=18 Subscriber plan number when supplied with REF qualifier 18.
Subscriber Group Number 2100C REF02 where REF01=6P Subscriber group number when supplied with REF qualifier 6P.
Subscriber Social Security Number 2100C REF02 where REF01=SY Subscriber Social Security Number when supplied. Treat as highly sensitive.
Other Subscriber References Other 2100C REF segments Other subscriber reference qualifier and identifier pairs preserved in source order.
Subscriber Address Line 1 2100C N301 First address line of the subscriber.
Subscriber Address Line 2 2100C N302 Second address line of the subscriber when supplied.
Subscriber City 2100C N401 City of the subscriber address.
Subscriber State 2100C N402 State or province code of the subscriber address.
Subscriber Postal Code 2100C N403 Postal code of the subscriber address.
Subscriber Country Code 2100C N404 Country code of the subscriber address when supplied.
Subscriber Location Qualifier 2100C N405 Qualifier identifying the location identifier in N406.
Subscriber Location ID 2100C N406 Location identifier associated with the qualifier in N405.
Subscriber Country Subdivision 2100C N407 Country subdivision code when supplied.
Subscriber Provider Code 2100C PRV01 Provider role or type code supplied in subscriber context.
Subscriber Provider ID Qualifier 2100C PRV02 Qualifier identifying the provider specialty or taxonomy value in PRV03.
Subscriber Provider Specialty ID 2100C PRV03 Provider specialty or taxonomy identifier supplied in subscriber context.
Subscriber Provider State 2100C PRV04 Provider state or province value when supplied.
Other Subscriber Provider Data Other 2100C PRV elements/occurrences Supported additional subscriber PRV values serialized in source order within the current schema boundary.
Subscriber Birth Date Format 2100C DMG01 Format qualifier for the subscriber date of birth.
Subscriber Birth Date 2100C DMG02 Subscriber date of birth.
Subscriber Gender Code 2100C DMG03 Subscriber gender code when supplied.
Subscriber Gender Description 2100C DMG03 code translation Human-readable description of the subscriber gender code.
Subscriber Marital Status Code 2100C DMG04 Subscriber marital status code when supplied.
Subscriber Race/Ethnicity Codes 2100C DMG05 composite Race and ethnicity information from the DMG05 composite, preserving component order.
Subscriber Citizenship Status Code 2100C DMG06 Subscriber citizenship status code when supplied.
Subscriber Demographic Country Code 2100C DMG07 Country code associated with subscriber demographic information when supplied.
Subscriber Insured Indicator 2100C INS01 Yes/no indicator identifying insured status when INS is supplied.
Subscriber Relationship Code 2100C INS02 Individual relationship code supplied in the subscriber INS segment.
Subscriber Relationship Description 2100C INS02 code translation Human-readable description of the supplied subscriber relationship code.
Subscriber Maintenance Type Code 2100C INS03 Maintenance type code from the subscriber INS segment when supplied.
Subscriber Maintenance Reason Code 2100C INS04 Maintenance reason code from the subscriber INS segment when supplied.
Subscriber Benefit Status Code 2100C INS05 Benefit status code from the subscriber INS segment when supplied.
Subscriber Medicare Status Code 2100C INS06 composite Medicare status information from the subscriber INS06 composite when supplied.
Subscriber COBRA Qualifying Event Code 2100C INS07 COBRA qualifying event code when supplied.
Subscriber Employment Status Code 2100C INS08 Employment status code when supplied.
Subscriber Student Status Code 2100C INS09 Student status code when supplied.
Other Subscriber INS Data Other 2100C INS elements Other subscriber INS values not mapped to dedicated columns, preserved in element order.
Subscriber Plan Begin Date 2100C DTP03 where DTP01=346 Subscriber plan begin date when supplied.
Subscriber Plan End Date 2100C DTP03 where DTP01=347 Subscriber plan end date when supplied.
Subscriber Eligibility Begin Date 2100C DTP03 where DTP01=356 Subscriber eligibility begin date when supplied.
Subscriber Eligibility End Date 2100C DTP03 where DTP01=357 Subscriber eligibility end date when supplied.
Subscriber Card Issue Date Format 2100C DTP02 where DTP01 identifies card issue date Date format qualifier for the subscriber identification-card issue date.
Subscriber Card Issue Date 2100C DTP03 where DTP01 identifies card issue date Subscriber identification-card issue date when supplied.
Other Subscriber Dates Other 2100C DTP segments Other subscriber-level DTP qualifier, format, and value combinations preserved in source order.
Patient Trace Type Code Active patient TRN01 Trace type code for the active response patient.
Patient Trace Number Active patient TRN02 Reference identifier returned for matching the response to the original patient inquiry.
Patient Originating Company Identifier Active patient TRN03 Originating company identifier from the active patient trace segment.
Patient Trace Reference Identifier Active patient TRN04 Additional patient-level trace reference when supplied.
Patient Entity Code Active patient NM101 Entity Identifier Code for the subscriber or dependent patient associated with the response detail.
Patient Entity Description Active patient NM101 code translation Human-readable description of the patient entity code.
Patient Entity Type Active patient NM102 Entity type qualifier for the patient.
Patient Last Name Active patient NM103 Patient last name or organization name.
Patient First Name Active patient NM104 Patient first name.
Patient Middle Name Active patient NM105 Patient middle name or initial when supplied.
Patient Name Prefix Active patient NM106 Patient name prefix when supplied.
Patient Name Suffix Active patient NM107 Patient name suffix when supplied.
Patient ID Qualifier Active patient NM108 Qualifier identifying the patient identifier in NM109.
Patient ID Active patient NM109 Patient member, dependent, or other identification value returned in the response.
Patient Group/Policy Number Active patient REF02 where REF01=1L Group or policy number associated with the patient when supplied.
Patient Plan Number Active patient REF02 where REF01=18 Plan number associated with the patient when supplied.
Patient Group Number Active patient REF02 where REF01=6P Group number associated with the patient when supplied.
Patient Social Security Number Active patient REF02 where REF01=SY Patient Social Security Number when supplied. Treat as highly sensitive.
Other Patient References Other active patient REF segments Other patient reference qualifier and identifier pairs preserved in source order.
Patient Address Line 1 Active patient N301 First address line of the patient.
Patient Address Line 2 Active patient N302 Second address line of the patient when supplied.
Patient City Active patient N401 City of the patient address.
Patient State Active patient N402 State or province code of the patient address.
Patient Postal Code Active patient N403 Postal code of the patient address.
Patient Country Code Active patient N404 Country code of the patient address when supplied.
Patient Location Qualifier Active patient N405 Qualifier identifying the location identifier in N406.
Patient Location ID Active patient N406 Location identifier associated with the qualifier in N405.
Patient Country Subdivision Active patient N407 Country subdivision code when supplied.
Patient Provider Code Active patient PRV01 Provider role or type code supplied in patient context.
Patient Provider ID Qualifier Active patient PRV02 Qualifier identifying the provider specialty or taxonomy value in PRV03.
Patient Provider Specialty ID Active patient PRV03 Provider specialty or taxonomy identifier supplied in patient context.
Patient Provider State Active patient PRV04 Provider state or province value when supplied.
Other Patient Provider Data Other active patient PRV elements/occurrences Supported additional patient PRV values serialized in source order within the current schema boundary.
Patient Birth Date Format Active patient DMG01 Format qualifier for the patient date of birth.
Patient Birth Date Active patient DMG02 Patient date of birth.
Patient Gender Code Active patient DMG03 Patient gender code when supplied.
Patient Gender Description Active patient DMG03 code translation Human-readable description of the patient gender code.
Patient Marital Status Code Active patient DMG04 Patient marital status code when supplied.
Patient Race/Ethnicity Codes Active patient DMG05 composite Race and ethnicity information from the patient DMG05 composite, preserving component order.
Patient Citizenship Status Code Active patient DMG06 Patient citizenship status code when supplied.
Patient Demographic Country Code Active patient DMG07 Country code associated with patient demographic information when supplied.
Patient Insured Indicator Active patient INS01 Yes/no indicator identifying patient insured status when INS is supplied.
Patient Relationship Code Active patient INS02 / derived self for subscriber Individual relationship code for the patient. Subscriber benefit rows may normalize to 18/Self when no explicit relationship is supplied.
Patient Relationship Description Patient relationship code translation Human-readable description of the patient's relationship to the subscriber.
Patient Maintenance Type Code Active patient INS03 Maintenance type code from the patient INS segment when supplied.
Patient Maintenance Reason Code Active patient INS04 Maintenance reason code from the patient INS segment when supplied.
Patient Benefit Status Code Active patient INS05 Benefit status code from the patient INS segment when supplied.
Patient Medicare Status Code Active patient INS06 composite Medicare status information from the patient INS06 composite when supplied.
Patient COBRA Qualifying Event Code Active patient INS07 COBRA qualifying event code when supplied.
Patient Employment Status Code Active patient INS08 Employment status code when supplied.
Patient Student Status Code Active patient INS09 Student status code when supplied.
Other Patient INS Data Other active patient INS elements Other patient INS values not mapped to dedicated columns, preserved in element order.
Patient Plan Begin Date Active patient DTP03 where DTP01=346 Patient plan begin date when supplied.
Patient Plan End Date Active patient DTP03 where DTP01=347 Patient plan end date when supplied.
Patient Eligibility Begin Date Active patient DTP03 where DTP01=356 Patient eligibility begin date when supplied.
Patient Eligibility End Date Active patient DTP03 where DTP01=357 Patient eligibility end date when supplied.
Patient Card Issue Date Format Active patient DTP02 where DTP01 identifies card issue date Date format qualifier for the patient identification-card issue date.
Patient Card Issue Date Active patient DTP03 where DTP01 identifies card issue date Patient identification-card issue date when supplied.
Other Patient Dates Other active patient DTP segments Other patient-level DTP qualifier, format, and value combinations preserved in source order.
Request Validation Number N/A (converter; AAA occurrence) Sequential AAA occurrence number within the transaction or active response context.
Request Validation Level AAA loop context (derived) Level at which the request was rejected or could not be processed.
Request Validation Source Loop 2100A/2100B/2100C/2100D/2110C/2110D Loop containing the AAA segment represented by this row.
Valid Request Indicator AAA01 Indicator describing whether the submitted request information was valid for processing.
Valid Request Indicator Description AAA01 code translation Human-readable description of the valid request indicator.
Agency Qualifier Code AAA02 Code identifying the agency responsible for the reject reason code list when supplied.
Agency Qualifier Description AAA02 code translation Human-readable description of the agency qualifier.
Reject Reason Code AAA03 Code explaining why the eligibility inquiry could not be processed or why benefit information was not generated.
Reject Reason Description AAA03 code translation Human-readable description of the request-validation reject reason.
Follow-Up Action Code AAA04 Code describing the recommended or permitted follow-up action.
Follow-Up Action Description AAA04 code translation Human-readable description of the follow-up action.
Rejection Summary AAA01-AAA04 (derived) Concise human-readable summary of the request-validation rejection.
Benefit Detail Number N/A (converter; EB occurrence) Sequential EB occurrence number within the active subscriber or dependent patient context.
Benefit Source Loop 2110C / 2110D Subscriber or dependent eligibility/benefit information loop containing the EB segment.
Eligibility or Benefit Information Code EB01 Code identifying the type of eligibility, coverage, or benefit information returned.
Eligibility or Benefit Information Description EB01 code translation Human-readable description of the eligibility or benefit information code.
Coverage Level Code EB02 Coverage level associated with the returned benefit, such as individual or family.
Coverage Level Description EB02 code translation Human-readable description of the coverage level.
Service Type Codes EB03 repetitions All service type codes associated with this benefit detail, preserving repetition order.
Service Type Descriptions EB03 code translations Human-readable service type descriptions aligned to Service Type Codes.
Insurance Type Code EB04 Insurance type code associated with the benefit detail.
Insurance Type Description EB04 code translation Human-readable description of the insurance type code.
Plan Coverage Description EB05 Plan or benefit coverage description returned by the information source.
Time Period Qualifier EB06 Code identifying the time period applicable to the amount, percentage, or quantity.
Time Period Description EB06 code translation Human-readable description of the benefit time period.
Benefit Monetary Amount EB07 Monetary amount associated with the eligibility or benefit detail, such as a copayment or deductible amount.
Benefit Percentage EB08 Raw fractional value associated with the benefit detail; presentation may format .20 as 20 percent.
Quantity Qualifier EB09 Code identifying the type of quantity supplied in EB10.
Quantity Qualifier Description EB09 code translation Human-readable description of the quantity qualifier.
Benefit Quantity EB10 Quantity associated with the benefit limitation or usage information.
Authorization/Certification Indicator EB11 Indicator describing whether authorization or certification is required or applicable.
Authorization/Certification Description EB11 code translation Human-readable description of the authorization or certification indicator.
In-Plan Network Indicator EB12 Indicator describing whether the benefit applies in network, out of network, or under another network condition.
In-Plan Network Description EB12 code translation Human-readable description of the network indicator.
Medical Procedure ID Qualifier EB13-1 Qualifier identifying the code set used for the procedure or service code.
Procedure Code EB13-2 Procedure or service code associated with the benefit detail.
Procedure Modifier 1 EB13-3 First procedure modifier associated with the returned benefit.
Procedure Modifier 2 EB13-4 Second procedure modifier associated with the returned benefit.
Procedure Modifier 3 EB13-5 Third procedure modifier associated with the returned benefit.
Procedure Modifier 4 EB13-6 Fourth procedure modifier associated with the returned benefit.
Procedure Description EB13-7 Free-form procedure description when supplied.
Procedure Code Range End EB13-8 Ending procedure or service code when the composite identifies a code range.
Benefit Summary EB01-EB13 (derived) Concise human-readable summary of the returned benefit, cost-share, coverage, network, and procedure information.
Service Delivery Quantity Qualifier 2110C/2110D HSD01 Qualifier identifying the service-delivery quantity in HSD02.
Service Delivery Quantity Qualifier Description HSD01 code translation Human-readable description of the HSD quantity qualifier.
Service Delivery Quantity 2110C/2110D HSD02 Quantity associated with the service-delivery limitation or benefit.
Service Delivery Unit Code 2110C/2110D HSD03 Unit or basis-for-measurement code associated with HSD02.
Service Delivery Unit Description HSD03 code translation Human-readable description of the service-delivery unit code.
Sample Selection Modulus 2110C/2110D HSD04 Sample selection modulus or interval value when supplied.
Service Delivery Time Period Qualifier 2110C/2110D HSD05 Time period qualifier associated with the service-delivery limitation.
Service Delivery Time Period Description HSD05 code translation Human-readable description of the service-delivery time period.
Service Delivery Period Count 2110C/2110D HSD06 Number of periods associated with the service-delivery limitation.
Service Delivery Calendar Pattern Code 2110C/2110D HSD07 Calendar pattern code associated with service delivery when supplied.
Service Delivery Pattern Time Code 2110C/2110D HSD08 Time-of-day or delivery-pattern code associated with the service-delivery limitation.
Other Service Delivery Details Additional 2110C/2110D HSD segments Supported additional HSD occurrences serialized in source order within the current schema boundary.
Benefit Reference Qualifier 2110C/2110D REF01 Qualifier identifying the first benefit-level reference identifier.
Benefit Reference Qualifier Description REF01 code translation Human-readable description of the benefit reference qualifier.
Benefit Reference ID 2110C/2110D REF02 Benefit-level reference identifier.
Benefit Reference Description 2110C/2110D REF03 Free-form description associated with the benefit reference when supplied.
Benefit Plan Number 2110C/2110D REF02 where REF01=18 Plan number associated with the benefit detail when supplied.
Benefit Group/Policy Number 2110C/2110D REF02 where REF01=1L Group or policy number associated with the benefit detail when supplied.
Benefit Group Number 2110C/2110D REF02 where REF01=6P Group number associated with the benefit detail when supplied.
Other Benefit References Additional 2110C/2110D REF segments Additional benefit-level reference qualifier and identifier pairs preserved in source order.
Benefit Date Qualifier 2110C/2110D DTP01 Qualifier identifying the first date or date range associated with the benefit detail.
Benefit Date Qualifier Description DTP01 code translation Human-readable description of the benefit date qualifier.
Benefit Date Format 2110C/2110D DTP02 Format qualifier for the benefit date or date range.
Benefit Date/Range 2110C/2110D DTP03 Date or date range associated with the benefit detail.
Benefit Plan Begin Date 2110C/2110D DTP03 where DTP01=346 Plan begin date associated with the benefit detail.
Benefit Plan End Date 2110C/2110D DTP03 where DTP01=347 Plan end date associated with the benefit detail.
Benefit Eligibility Begin Date 2110C/2110D DTP03 where DTP01=356 Eligibility begin date associated with the benefit detail.
Benefit Eligibility End Date 2110C/2110D DTP03 where DTP01=357 Eligibility end date associated with the benefit detail.
Benefit Begin Date 2110C/2110D DTP03 where DTP01=348 Benefit begin date when supplied.
Benefit End Date 2110C/2110D DTP03 where DTP01=349 Benefit end date when supplied.
Benefit Service Date/Range 2110C/2110D DTP03 where DTP01=472 Service date or date range associated with the benefit detail when supplied.
Other Benefit Dates Additional 2110C/2110D DTP segments Additional benefit-level DTP qualifier, format, and value combinations preserved in source order.
Benefit Message Count 2110C/2110D MSG occurrences (derived) Number of MSG segments associated with the benefit detail.
Benefit Message First 2110C/2110D MSG01 First free-form message associated with the benefit detail.
All Benefit Messages All 2110C/2110D MSG segments All benefit messages preserved in source order.
Related Entity Count 2120C/2120D NM1 occurrences (derived) Number of benefit-related entity loops associated with the EB detail.
Primary Related Entity Source Loop 2120C / 2120D Loop containing the first benefit-related entity associated with the EB detail.
Primary Related Entity Code First 2120C/2120D NM101 Entity Identifier Code for the first benefit-related entity, such as primary care provider or plan sponsor.
Primary Related Entity Description First related NM101 code translation Human-readable description of the primary related entity code.
Primary Related Entity Type First related NM102 Entity type qualifier for the primary related entity.
Primary Related Entity Name First related NM103 Organization or last name of the primary related entity.
Primary Related Entity First Name First related NM104 First name of the primary related entity when it is an individual.
Primary Related Entity Middle Name First related NM105 Middle name or initial of the primary related entity when supplied.
Primary Related Entity Name Prefix First related NM106 Name prefix of the primary related entity when supplied.
Primary Related Entity Name Suffix First related NM107 Name suffix of the primary related entity when supplied.
Primary Related Entity ID Qualifier First related NM108 Qualifier identifying the primary related entity identifier in NM109.
Primary Related Entity ID First related NM109 Primary identifier of the benefit-related entity.
Primary Related Entity NPI First related NM109 where NM108=XX (derived) National Provider Identifier when the primary related entity identifier qualifier is XX.
Primary Related Entity Service Provider Number First related NM109 where NM108=SV (derived) Service provider number when the primary related entity identifier qualifier is SV.
Primary Related Entity Payer ID First related NM109 where NM108=PI (derived) Payer identifier when the primary related entity identifier qualifier is PI.
Primary Related Entity Tax ID First related NM109 where NM108=FI (derived) Federal tax identifier when the primary related entity identifier qualifier is FI.
Primary Related Entity References First 2120C/2120D REF segments Reference qualifier and identifier pairs associated with the primary related entity.
Primary Related Entity Address Line 1 First related N301 First address line of the primary related entity.
Primary Related Entity Address Line 2 First related N302 Second address line of the primary related entity when supplied.
Primary Related Entity City First related N401 City of the primary related entity address.
Primary Related Entity State First related N402 State or province code of the primary related entity address.
Primary Related Entity Postal Code First related N403 Postal code of the primary related entity address.
Primary Related Entity Country Code First related N404 Country code of the primary related entity address when supplied.
Primary Related Entity Location Qualifier First related N405 Qualifier identifying the location identifier in N406.
Primary Related Entity Location ID First related N406 Location identifier associated with the qualifier in N405.
Primary Related Entity Country Subdivision First related N407 Country subdivision code when supplied.
Primary Related Entity Provider Code First related PRV01 Provider role or type code supplied for the primary related entity.
Primary Related Entity Provider ID Qualifier First related PRV02 Qualifier identifying the specialty or taxonomy value in PRV03.
Primary Related Entity Provider Specialty ID First related PRV03 Provider specialty or taxonomy identifier supplied for the primary related entity.
Primary Related Entity Provider State First related PRV04 Provider state or province value when supplied.
Other Primary Related Entity Provider Data Other first-related PRV elements/occurrences Supported additional PRV values for the primary related entity serialized within the current schema boundary.
Primary Related Entity Contact Function Code First related PER01 Code identifying the function of the primary related entity contact.
Primary Related Entity Contact Function Description First related PER01 code translation Human-readable description of the contact function.
Primary Related Entity Contact Name First related PER02 Name of the primary related entity contact.
Primary Related Entity Communication Qualifier 1 First related PER03 Qualifier identifying the first communication value in PER04.
Primary Related Entity Communication Description 1 First related PER03 code translation Human-readable description of the first communication qualifier.
Primary Related Entity Communication Number 1 First related PER04 First contact number or address for the primary related entity.
Primary Related Entity Communication Qualifier 2 First related PER05 Qualifier identifying the second communication value in PER06.
Primary Related Entity Communication Description 2 First related PER05 code translation Human-readable description of the second communication qualifier.
Primary Related Entity Communication Number 2 First related PER06 Second contact number or address for the primary related entity.
Primary Related Entity Communication Qualifier 3 First related PER07 Qualifier identifying the third communication value in PER08.
Primary Related Entity Communication Description 3 First related PER07 code translation Human-readable description of the third communication qualifier.
Primary Related Entity Communication Number 3 First related PER08 Third contact number or address for the primary related entity.
All Related Entities All 2120C/2120D NM1/REF/N3/N4/PER/PRV loops Serialized supported content for benefit-related entities associated with this EB detail in source order; not a complete hierarchical X12 export.

Routing, grain, and privacy contract

  • Smart Mapping supports ST01 271 when ST03 is exactly 005010X279A1. If ST03 is blank, GS08 must be exactly 005010X279A1. Near-match and unsupported versions are available only in Raw segments mode.
  • A supported response uses functional group GS01=HB. ST03 is the implementation convention/version identifier.
  • Smart Mapping emits one row per EB benefit occurrence or AAA rejection occurrence. Repeated EB03 service types remain in source order in one EB row. A member without EB or AAA produces no Smart Mapping detail row.
  • De-identify PHI protects mapped rows, validation, summary, and Smart Mapping downloads. Raw segments mode intentionally retains the original EDI and is not de-identified.

EB01-EB13 interpretation

Read one EB occurrence as a unit: EB01 benefit/eligibility information code; EB02 coverage level; repeated EB03 service types; EB04 insurance type; EB05 plan description; EB06 time period; EB07 amount; EB08 percentage; EB09 quantity qualifier; EB10 quantity; EB11 authorization/certification indicator; EB12 network indicator; and EB13 procedure composite.

  • EB07 amounts are context-specific. Do not simply sum deductibles, copays, limitations, benefits, time periods, or service types unless the business context supports it.
  • The raw EB08 fractional value is retained; presentation may display .20 as 20%.
  • Network status comes only from EB12: Y = In Network, N = Out of Network, W = Not Applicable, and U = Unknown. Provider information is not a network fallback.
  • Common EB02 values receive conservative labels; unknown coverage-level codes remain raw and are not assigned an invented meaning. Known EB06 values receive time-period descriptions; unknown codes remain raw.

Nested occurrence behavior

  • The first HSD is fully columnized. Later HSD occurrences remain in Other Service Delivery Details in supported source order.
  • Member REF qualifiers populate qualifier-specific fields. The first benefit REF supplies convenience columns; later benefit REF evidence remains in Other Benefit References. A generic first REF is not assigned a specific business meaning without its qualifier.
  • Patient/member DTPs remain at patient scope. At benefit scope, the first DTP supplies convenience columns, recognized qualifiers also populate aliases, and later occurrences remain in Other Benefit Dates. Analysis exposes each supported benefit DTP with qualifier, D8/RD8 format, source value, display value, and owning EB.
  • Multiple benefit MSG segments are valid. All Benefit Messages retains supported occurrences in source order, and Analysis exposes each protected message. A valid MSG after a benefit-level AAA remains owned by the EB and appears exactly once.
  • AAA rows represent rejection or processing response details at their source hierarchy level; they are not claim acknowledgments.
  • The first related entity supplies convenience fields. All Related Entities serializes supported related-entity content in source order. NPI is populated only when NM108 is XX.

Current support boundaries

The 369 fields describe the current Smart Mapping schema, not every possible X279/X279A1 construct. III is unsupported; code dictionaries are intentionally partial; first/later PER and HSD convenience columns are bounded; and response-less member rows are not emitted. Serialized fields retain supported mapped occurrences, but they are not a complete or lossless hierarchical X12 export. Use Raw segments mode when the original source breadth is required.

Parse an EDI 271 into structured fields.
Browse the other Client-Side EDI data maps and tutorials.