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EDIFACT message guide · Healthcare and social

IHCEBI Interactive health insurance eligibility and benefits inquiry and response

The UN/EDIFACT interactive message providers use to ask a patient's health insurer about eligibility and benefits, with an immediate response.

Sent by
Healthcare provider or administrative service
Received by
Health insurer or funding institution
Standard
UN/EDIFACT · Interactive (I-EDI) message
X12 equivalent
270 Eligibility, Coverage or Benefit Inquiry

What is the EDIFACT IHCEBI message?

IHCEBI is the UN/EDIFACT interactive health insurance eligibility and benefits inquiry and response. The directory defines it as a message sent from institutional or individual healthcare providers, or those providing related administrative services, to a funding institution to obtain health insurance information from a patient's insurer.

As an interactive message, the inquiry and the answer are exchanged in one dialogue. Providers check coverage before treatment, so they know whether the patient is insured, what is covered and what the patient must pay.

How the EDIFACT IHCEBI message worksDiagram of the UN/EDIFACT IHCEBI Interactive health insurance eligibility and benefits inquiry and response message. Healthcare provider or administrative service sends it to health insurer or funding institution. It usually starts the exchange. It is usually followed by IHCLME. Inside the UIB and UIH envelopes, the directory D.21A requires, in the start of message: MSD (Message action details). 2 conditional segment groups are listed by their trigger segment.How the EDIFACT IHCEBI message worksInteractive health insurance eligibility and benefits inquiry and response: who sends it, where it fits and whatthe directory marks mandatory1 WHERE IT FITSUSUALLY FOLLOWSStarts the exchangeIHCEBISENDERHealthcare provider oradministrative serviceRECEIVERHealth insurer orfunding institutionUSUALLY FOLLOWED BYIHCLMEHealth care claim orencounter request andresponse2 WHAT DIRECTORY D.21A REQUIRESInteractive interchangeUIB … UIZMessage IHCEBIUIH … UITSTART OF MESSAGEMSDMessage action detailsBODY AND SEGMENT GROUPS+ 2 conditional groups, starting with:PRTDTIBlue box: mandatory segment group. Conditional groups are listed by the trigger segment that starts them; a group is sent only when its data applies.Conditional segments outside groups are not drawn.Structure: mandatory segments and groups in the UN/EDIFACT directory D.21A listing for IHCEBI. Your trading partner's implementation guide adds itsown requirements.
How the EDIFACT IHCEBI message worksDiagram of the UN/EDIFACT IHCEBI Interactive health insurance eligibility and benefits inquiry and response message. Healthcare provider or administrative service sends it to health insurer or funding institution. It usually starts the exchange. It is usually followed by IHCLME. Inside the UIB and UIH envelopes, the directory D.21A requires, in the start of message: MSD (Message action details). 2 conditional segment groups are listed by their trigger segment.How the EDIFACT IHCEBImessage worksInteractive health insurance eligibility andbenefits inquiry and response: who sends it,where it fits and what the directory marksmandatory1 WHERE IT FITSUSUALLY FOLLOWSStarts the exchangeIHCEBISENDERHealthcareprovider oradministrativeserviceRECEIVERHealth insurer orfundinginstitutionUSUALLY FOLLOWED BYIHCLMEHealth care claim or encounterrequest and response2 WHAT DIRECTORY D.21A REQUIRESInteractive interchange (UIB … UIZ)Message IHCEBI (UIH … UIT)START OF MESSAGEMSDMessage action detailsBODY AND SEGMENT GROUPS+ 2 conditional groups, starting with:PRTDTIBlue box: mandatory segment group. Conditionalgroups are listed by the trigger segment thatstarts them; a group is sent only when its dataapplies. Conditional segments outside groups arenot drawn.Structure: mandatory segments and groups in theUN/EDIFACT directory D.21A listing for IHCEBI.Your trading partner's implementation guide adds itsown requirements.

How to read this diagram: the top row shows who sends IHCEBI, to whom, and which messages usually come before and after it. The lower part shows what the directory D.21A itself requires: the envelopes around IHCEBI and the segments and segment groups it marks mandatory. Conditional groups are listed by their trigger segment rather than drawn in full. This is the directory's minimum, not a trading partner's requirement: a message implementation guide usually makes some conditional groups mandatory, restricts the codes and may use an older directory.

Expand diagram Download SVG

When it is used

  • Checking a patient's coverage before treatment
  • Confirming benefits for a planned procedure
  • Verifying eligibility at registration

Where it fits in the message flow

This message IHCEBI Interactive health insurance eligibility and benefits inquiry and response
Usually followed by IHCLME Health care claim or encounter request and response

Structure

Mandatory segments in IHCEBI (directory D.21A)

In UN/EDIFACT directory D.21A, the IHCEBI message has 15 segment positions arranged in 3 segment groups. These are the segments and segment groups marked mandatory at message level, in order; a mandatory group is shown with the segment that starts it. Segments inside conditional groups are needed only when the group is used. This is the directory’s requirement, not your trading partner’s: each partner’s message implementation guide names the directory it uses, often an older one such as D.96A or D.01B where the structure can differ, makes some conditional segments mandatory and restricts the codes. This structure comes from one published copy of the directory and has not been independently verified: confirm it before you build a map.

  • UIH
  • MSD
  • UIT

Practical example

IHCEBI in practice

At registration for an outpatient procedure, the clinic's system sends the patient's insurer an IHCEBI inquiry. The insurer responds immediately that the patient is covered, the procedure requires a co-payment and a prior authorization is on file. The clinic informs the patient before treatment.

Implementation

Implementation considerations for IHCEBI

  • Design for fast, reliable connections, since answers are immediate.
  • Comply with health data protection laws.
  • Identify patients and insurers reliably.
  • Check which interactive standards insurers support.

How ECOM helps

Automate IHCEBI with ECOM

Industry

Healthcare

Secure B2B integration and file transfer for providers, suppliers, distributors and healthcare partners.

Solution

Batch and Real-Time Integration

Scheduled batch processing and real-time, API-driven integration on one platform.

Solution

EDI Integration

Exchange X12 and EDIFACT documents with partners and integrate them directly with your ERP.

Compare X12 and EDIFACT, or see answers to general questions in the EDI FAQ.

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