Eligibility Overview

about eligibility eligibility provides providers with the electronic delivery of pbm/payer member data at the point of care through the provider vendor interface, the provider can request patient information such as eligibility and pharmacy benefit coverage information about this guide this surescripts eligibility companion guide was created to assist pharmacy benefit managers (pbms)/payers and provider vendors in developing and transferring messages needed to provide pbm/payer member data regarding eligibility information and pharmacy benefit coverage, at the point of care the id load allows pbm/payers to provide surescripts with their member roster to populate the surescripts master patient index (mpi) this guide also includes eligibility for pharmacy information notes the terms pbm/payer or processor, who acts on behalf of the pbm/payer, are referred to as pbm/payer throughout this guide the terms message and transaction are used interchangeably throughout this guide the term transaction will be used when referring to x12n/005010x279a1 health care eligibility benefit inquiry and response (270/271) for the purposes of this guide, the term provider vendor also includes pharmacies the terms cancellation, termination, or expiration are used interchangeably throughout this guide the audience for this document includes any customer responsible for developing a system interface for these electronic prescribing messages note usage throughout this guide, different note styles are used for the following purposes note this is used when a note is required for content specific to surescripts reference this is used when referencing ncpdp documentation document references this guide is meant to support and integrate with the x12 standard guides where applicable it does not reproduce the base standard in its entirety customers should read and comprehend the associated standards prior to reading this guide please reference the following documents when reading this guide document title asc x12n/005010x279a1 health care eligibility benefit inquiry and response (270/271) asc x12n/005010x231a1 implementation acknowledgement for health care insurance (999) surescripts connectivity and authentication implementation guide https //docs surescripts com/connectivity authentication/guide for sections of this guide pertaining to x12 standards “materials reproduced with the consent of” copyright i 2009, data interchange standards association on behalf of asc x12 format i 2009 washington publishing company all rights reserved users of this guide must purchase their own copy of the asc x12n/005010x279a1 (270/271) and x12n/005010x231a1 (999) as this guide only includes a subset of those guides go to https //x12 org http //store x12 org/ to obtain your copy