PAYER READY CREDENTIALING & COMPLIANCE

Credentialing Glossary

EDI 270/271

billing

Definition

Eligibility verification transaction. 270 is the request you send to a payer (subscriber, date of service, service type code), 271 is the response showing active coverage, deductible status, copay/coinsurance, and benefits. Most clean-claim workflows verify eligibility 24-48 hours before a scheduled visit to catch coverage termination before service.

Every month un-credentialed is revenue you never bill

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