All PlansAdministrativeHigh impact
Member eligibility response (271) changes coming Sept. 1
Priority Health·Provider News
Effective date
Sep 1, 2026
We identified it
Jul 1, 2026
Summary
Effective September 1, 2026, Priority Health will transition member eligibility response (271) data to Epic's X12 format, which displays more comprehensive benefit information. Key changes include: benefits now show all tier levels regardless of provider network status, $0 copays/coinsurance are implied (not displayed), and historical inactive benefits appear with flags. Billing teams must adjust interpretation workflows to match specific services to active benefits and verify eligibility carefully before estimating patient financial responsibility.
Action Required
By August 15, 2026: Billing team must implement new 271 response interpretation procedures for Priority Health. (1) Update eligibility verification workflow to identify and focus ONLY on active benefits matching the specific date of service and setting—ignore inactive benefits flagged in Epic 271 output. (2) Modify patient financial responsibility estimation process: do NOT assume $0 copay/coinsurance when amounts are blank; instead, recognize blank = $0 applies. (3) Retrain staff to review ALL displayed benefit tiers (Tier 1, Tier 2, out-of-network) rather than assuming matched benefits to provider's network tier. (4) Document the new Epic 271 format in billing procedures and encounter templates. (5) Add verification step before claim submission to confirm benefit interpretation matches the actual service rendered. Failure to adjust interpretation may result in incorrect patient billing, claim denials, or eligibility mismatches. Reference Epic's ANSI X12 Outgoing 271 Technical Specifications for detailed field mappings.