How to map a Medicare 271 eligibility response to a CWF
Jun 2, 2025
Healthcare
Stedi’s Eligibility Check APIs let you get Medicare 271 eligibility responses as JSON. But your system – or one downstream – might need to display that JSON data in Common Working File (CWF) fields. Many providers still expect a CWF-style layout.
This guide shows how to map Stedi’s JSON 271 eligibility responses to CWF fields. It also covers what the CWF was, how Medicare eligibility checks work today, and why the CWF format still persists.
What Is the Common Working File (CWF)?
The Centers for Medicare & Medicaid Services (CMS) built the CWF in the 1980s to centrally manage Medicare eligibility. It was the source of truth for who was covered, when, and under which Medicare part.
The system produced fixed-format text files – also called “CWFs” – for mainframe terminals and printed reports. Each file had a set layout, with fields like member ID, coverage type, and benefit dates. For example:
How Medicare eligibility checks work today
CMS replaced the CWF in 2019 with the HIPAA Eligibility Transaction System (HETS). HETS returns standard 271 eligibility responses, the same as commercial insurers. Medicare 271s include a lot of Medicare-specific info, including:
Medicare Part A and Part B entitlements and dates
Part C (Medicare Advantage) and Part D (Prescription Drug) plan info
Deductibles, copays, and benefit limits
Remaining Skilled Nursing Facility (SNF) days
ESRD transplant or dialysis dates
Smoking cessation visits and therapy caps
Qualified Medicare Beneficiary (QMB), secondary payers, Medicaid crossover, and other coordination of benefits information.
In Stedi’s JSON 271 eligibility responses, that data lives under benefitsInformation. Each object describes a specific coverage, limit, or service type. For example:
{
...
"subscriber": {
"memberId": "123456789",
"firstName": "JANE",
"lastName": "DOE",
...
},
...
"benefitsInformation": [
{
"code": "B",
"name": "Co-Payment",
"serviceTypeCodes": ["30"],
"serviceTypes": ["Health Benefit Plan Coverage"],
"insuranceTypeCode": "MA",
"insuranceType": "Medicare Part A",
"timeQualifierCode": "7",
"timeQualifier": "Day",
"benefitAmount": "408",
"inPlanNetworkIndicatorCode": "W",
"inPlanNetworkIndicator": "Not Applicable",
"benefitsDateInformation": {
"admission": "20241231",
"admissions": [
{
"startDate": "20240101",
"endDate": "20241231"
}
]
},
"benefitsServiceDelivery": [
{
"unitForMeasurementCode": "Days",
"timePeriodQualifierCode": "30",
"timePeriodQualifier": "Exceeded",
"numOfPeriods": "60",
"unitForMeasurementQualifierCode": "DA",
"unitForMeasurementQualifier": "Days"
},
{
"unitForMeasurementCode": "Days",
"timePeriodQualifierCode": "31",
"timePeriodQualifier": "Not Exceeded",
"numOfPeriods": "90",
"unitForMeasurementQualifierCode": "DA",
"unitForMeasurementQualifier": "Days"
},
{
"timePeriodQualifierCode": "26",
"timePeriodQualifier": "Episode",
"numOfPeriods": "1"
}
]
}
]
}How to use this guide
Stedi’s JSON 271 eligibility response is easier to use in modern applications. But if your customers need the old CWF layout, you’ll need to map each field from JSON.
This guide isn’t an official spec. It’s a practical reference. Each section shows a CWF-style layout, a table of field mappings, and notes on when to use each field. For details on our JSON 271 eligibility responses, see our API documentation.
Provider information
CWF field | JSON 271 eligibility response property |
|---|---|
Organization Name |
|
NPI ID |
|
Patient Demographics
The following table includes patient demographics from the SUBMITTED TO PAYER and RETURNED BY PAYER sections of the sample CWF.
CWF field | JSON 271 eligibility response property | When to use |
|---|---|---|
SUBMITTED TO PAYER | ||
First Name |
| |
Last Name |
| |
Member ID (MBI) |
| |
D.O.B. |
| |
Eligibility Date(From) |
|
|
Eligibility Date(To) |
|
|
Service Types(s) |
| |
RETURNED TO PAYER | ||
First Name |
| |
Middle Name |
| |
Last Name |
| |
Suffix |
| |
Member ID (MBI) |
| |
D.O.B. |
| |
Gender |
| |
Address Line 1 |
| |
Address Line 2 |
| |
City |
| |
State |
| |
Zip Code |
| |
Benefit Information
In the JSON 271 eligibility response, benefitsInformation objects contain most of the benefits information.
The benefitsInformation.insuranceTypeCode property indicates the type of insurance policy within a program, such as Medicare. A code of MA indicates Medicare Part A. A code of MB indicates Medicare Part B. For a complete list of insurance type codes, see Insurance Type Codes in our docs.
The benefitsInformation.serviceTypeCodes property identifies the type of healthcare services the benefits information relates to. A service type code (STC) of 30 relates to general benefits information. For a complete list of STCs, see Service Type Codes in our docs.
CWF field | JSON 271 eligibility response property | When to use |
|---|---|---|
Effective Date |
| All of the following must be true:
|
Termination Date |
| All of the following must be true:
|
Ineligible Start |
| All of the following must be true:
|
Ineligible End |
| All of the following must be true:
|
Date of Death |
| |
Lifetime Psychiatric Days |
| All of the following must be true:
|
Lifetime Reserve Days |
| All of the following must be true:
|
Smoking Cessation Days |
| All of the following must be true:
|
Initial Cessation Date |
| This information is only available if an initial counseling visit was used in the past 12 months. All of the following must be true:
|
ESRD Dialysis Date |
| All of the following must be true:
|
ESRD Transplant Date |
| All of the following must be true:
|
ESRD Coverage Period |
| All of the following must be true:
|
Plan Benefits
CWF field | JSON 271 eligibility response property | When to use |
|---|---|---|
Medicare Part A | ||
Type | Use Base when all of the following are true:
Use Spell when all of the following are true:
| |
First Bill |
| |
Last Bill |
| |
Hospital Days Full | For a Type of Base, use For a Type of Base, use | |
Hospital Days Colns | For a Type of Base, use
For a Type of Base, use
| |
Hospital Days Base |
| |
SNF Days Full |
| All of the following must be true:
|
SNF Days Colns |
| All of the following must be true:
|
SNF Days Base |
| All of the following must be true:
|
Inpatient Deductible |
| All of the following must be true:
|
Medicare Part B | ||
Deductible Remaining |
| All of the following must be true:
|
Physical Therapy |
| All of the following must be true:
|
Occupational Therapy |
| All of the following must be true:
|
Blood Pints Part A/B |
| All of the following must be true:
|
Medicare Part A Stays | ||
Type | Use Hospital when:
Use Hospital Stay when:
Use SNF Stay when:
| The following must be true:
|
Start Date |
|
|
End Date |
|
|
Billing NPI |
| The following must be true:
|
Qualified Medicare Beneficiary (QMB) Status
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=R(Other or Additional Payor)benefitsInformation.insuranceTypeCode=QM(Qualified Medicare Beneficiary)
CWF field | JSON 271 eligibility response property | When to use |
Period From |
|
|
Period Through |
|
|
QMB Plan |
|
Medicare Secondary Payor
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=R(Other or Additional Payor)benefitsInformation.serviceTypeCodes=30(Health Benefit Plan Coverage)benefitsInformation.insuranceTypeCode=14,15,47, orWC
CWF field | JSON 271 eligibility response property | When to use |
Effective Date |
|
|
Termination Date |
|
|
Policy Number |
| |
Insurer |
| |
Address |
| |
Type |
|
Medicare Advantage
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=U(Contact Following Entity for Eligibility or Benefit Information)benefitsInformation.serviceTypeCodes=30(Health Benefit Plan Coverage) OR both30(Health Benefit Plan Coverage) ANDCQ(Case Management)benefitsInformation.insuranceTypeCode=HM(HMO),HN(HMO - Medicare Risk),IN(Indemnity),PR(PPO), orPS(POS)benefitsInformation.benefitsRelatedEntities.entityIdentifier=Primary Payer
CWF field | JSON 271 eligibility response property | When to use |
Effective Date |
|
|
Termination Date |
|
|
Plan Code |
| |
Payer Name |
| |
Address |
| |
Plan Name |
| |
Website |
| The following must be true:
In most cases, CMS only provides just the payer’s domain name, such as |
Phone Number |
| The following must be true:
|
Message(s) |
|
Part D
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=R(Other or Additional Payor)benefitsInformation.serviceTypeCodes=88(Pharmacy)
CWF field | JSON 271 eligibility response property | When to use |
Effective Date |
|
|
Termination Date |
|
|
Plan Code |
| |
Payer Name |
| |
Address |
| |
Plan Name |
| |
Website |
| The following must be true:
In most cases, CMS only provides just the payer’s domain name, such as |
Phone Number |
| The following must be true:
|
Therapy Caps
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=D(Benefit Description)benefitsInformation.serviceTypeCodes=AD(Occupational Therapy) orAE(Physical Medicine)
CWF field | JSON 271 eligibility response property | When to use |
Period Begin |
|
|
Period End |
|
|
PT/ST Applied |
| |
OT Applied |
|
Hospice
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=X(Health Care Facility)benefitsInformation.serviceTypeCodes=45(Hospice)
CWF field | JSON 271 eligibility response property | When to use |
Benefit Period | No direct mapping. Calculated by ordering the episodes by date for the calendar year. | |
Benefit Period Start Date |
|
|
Benefit Period End Date |
| benefitsInformation.benefitsDateInformation.benefit can be either a single date ( |
Provider |
| The following must be true:
|
Provider Name |
| The following must be true:
|
Hospice Elections | ||
Election Date |
|
|
Election Receipt Date |
| |
Election Revocation Date |
| |
Election Revocation Code |
| |
Election NPI |
| |
Home Health Certification
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=X(Health Care Facility)benefitsInformation.compositeMedicalProcedureIdentifier.procedureCode=G0180
CWF field | JSON 271 eligibility response property |
Certification HCPCS Code |
|
Process Date |
|
Rehabilitation Services
CWF field | JSON 271 eligibility response property | When to use |
Pulmonary Remaining (G0424) Technical |
| All of the following must be true:
|
Pulmonary Remaining (G0424) Professional |
| All of the following must be true:
|
Cardiac Applied (93797, 93798) Technical |
| All of the following must be true:
|
Cardiac Applied (93797, 93798) Professional |
| All of the following must be true:
|
Intensive Cardiac Applied (G0422, G0423) Technical |
| All of the following must be true:
|
Intensive Cardiac Applied (G0422, G0423) Professional |
| All of the following must be true:
|
Stedi’s Eligibility Check APIs let you get Medicare 271 eligibility responses as JSON. But your system – or one downstream – might need to display that JSON data in Common Working File (CWF) fields. Many providers still expect a CWF-style layout.
This guide shows how to map Stedi’s JSON 271 eligibility responses to CWF fields. It also covers what the CWF was, how Medicare eligibility checks work today, and why the CWF format still persists.
What Is the Common Working File (CWF)?
The Centers for Medicare & Medicaid Services (CMS) built the CWF in the 1980s to centrally manage Medicare eligibility. It was the source of truth for who was covered, when, and under which Medicare part.
The system produced fixed-format text files – also called “CWFs” – for mainframe terminals and printed reports. Each file had a set layout, with fields like member ID, coverage type, and benefit dates. For example:
How Medicare eligibility checks work today
CMS replaced the CWF in 2019 with the HIPAA Eligibility Transaction System (HETS). HETS returns standard 271 eligibility responses, the same as commercial insurers. Medicare 271s include a lot of Medicare-specific info, including:
Medicare Part A and Part B entitlements and dates
Part C (Medicare Advantage) and Part D (Prescription Drug) plan info
Deductibles, copays, and benefit limits
Remaining Skilled Nursing Facility (SNF) days
ESRD transplant or dialysis dates
Smoking cessation visits and therapy caps
Qualified Medicare Beneficiary (QMB), secondary payers, Medicaid crossover, and other coordination of benefits information.
In Stedi’s JSON 271 eligibility responses, that data lives under benefitsInformation. Each object describes a specific coverage, limit, or service type. For example:
{
...
"subscriber": {
"memberId": "123456789",
"firstName": "JANE",
"lastName": "DOE",
...
},
...
"benefitsInformation": [
{
"code": "B",
"name": "Co-Payment",
"serviceTypeCodes": ["30"],
"serviceTypes": ["Health Benefit Plan Coverage"],
"insuranceTypeCode": "MA",
"insuranceType": "Medicare Part A",
"timeQualifierCode": "7",
"timeQualifier": "Day",
"benefitAmount": "408",
"inPlanNetworkIndicatorCode": "W",
"inPlanNetworkIndicator": "Not Applicable",
"benefitsDateInformation": {
"admission": "20241231",
"admissions": [
{
"startDate": "20240101",
"endDate": "20241231"
}
]
},
"benefitsServiceDelivery": [
{
"unitForMeasurementCode": "Days",
"timePeriodQualifierCode": "30",
"timePeriodQualifier": "Exceeded",
"numOfPeriods": "60",
"unitForMeasurementQualifierCode": "DA",
"unitForMeasurementQualifier": "Days"
},
{
"unitForMeasurementCode": "Days",
"timePeriodQualifierCode": "31",
"timePeriodQualifier": "Not Exceeded",
"numOfPeriods": "90",
"unitForMeasurementQualifierCode": "DA",
"unitForMeasurementQualifier": "Days"
},
{
"timePeriodQualifierCode": "26",
"timePeriodQualifier": "Episode",
"numOfPeriods": "1"
}
]
}
]
}How to use this guide
Stedi’s JSON 271 eligibility response is easier to use in modern applications. But if your customers need the old CWF layout, you’ll need to map each field from JSON.
This guide isn’t an official spec. It’s a practical reference. Each section shows a CWF-style layout, a table of field mappings, and notes on when to use each field. For details on our JSON 271 eligibility responses, see our API documentation.
Provider information
CWF field | JSON 271 eligibility response property |
|---|---|
Organization Name |
|
NPI ID |
|
Patient Demographics
The following table includes patient demographics from the SUBMITTED TO PAYER and RETURNED BY PAYER sections of the sample CWF.
CWF field | JSON 271 eligibility response property | When to use |
|---|---|---|
SUBMITTED TO PAYER | ||
First Name |
| |
Last Name |
| |
Member ID (MBI) |
| |
D.O.B. |
| |
Eligibility Date(From) |
|
|
Eligibility Date(To) |
|
|
Service Types(s) |
| |
RETURNED TO PAYER | ||
First Name |
| |
Middle Name |
| |
Last Name |
| |
Suffix |
| |
Member ID (MBI) |
| |
D.O.B. |
| |
Gender |
| |
Address Line 1 |
| |
Address Line 2 |
| |
City |
| |
State |
| |
Zip Code |
| |
Benefit Information
In the JSON 271 eligibility response, benefitsInformation objects contain most of the benefits information.
The benefitsInformation.insuranceTypeCode property indicates the type of insurance policy within a program, such as Medicare. A code of MA indicates Medicare Part A. A code of MB indicates Medicare Part B. For a complete list of insurance type codes, see Insurance Type Codes in our docs.
The benefitsInformation.serviceTypeCodes property identifies the type of healthcare services the benefits information relates to. A service type code (STC) of 30 relates to general benefits information. For a complete list of STCs, see Service Type Codes in our docs.
CWF field | JSON 271 eligibility response property | When to use |
|---|---|---|
Effective Date |
| All of the following must be true:
|
Termination Date |
| All of the following must be true:
|
Ineligible Start |
| All of the following must be true:
|
Ineligible End |
| All of the following must be true:
|
Date of Death |
| |
Lifetime Psychiatric Days |
| All of the following must be true:
|
Lifetime Reserve Days |
| All of the following must be true:
|
Smoking Cessation Days |
| All of the following must be true:
|
Initial Cessation Date |
| This information is only available if an initial counseling visit was used in the past 12 months. All of the following must be true:
|
ESRD Dialysis Date |
| All of the following must be true:
|
ESRD Transplant Date |
| All of the following must be true:
|
ESRD Coverage Period |
| All of the following must be true:
|
Plan Benefits
CWF field | JSON 271 eligibility response property | When to use |
|---|---|---|
Medicare Part A | ||
Type | Use Base when all of the following are true:
Use Spell when all of the following are true:
| |
First Bill |
| |
Last Bill |
| |
Hospital Days Full | For a Type of Base, use For a Type of Base, use | |
Hospital Days Colns | For a Type of Base, use
For a Type of Base, use
| |
Hospital Days Base |
| |
SNF Days Full |
| All of the following must be true:
|
SNF Days Colns |
| All of the following must be true:
|
SNF Days Base |
| All of the following must be true:
|
Inpatient Deductible |
| All of the following must be true:
|
Medicare Part B | ||
Deductible Remaining |
| All of the following must be true:
|
Physical Therapy |
| All of the following must be true:
|
Occupational Therapy |
| All of the following must be true:
|
Blood Pints Part A/B |
| All of the following must be true:
|
Medicare Part A Stays | ||
Type | Use Hospital when:
Use Hospital Stay when:
Use SNF Stay when:
| The following must be true:
|
Start Date |
|
|
End Date |
|
|
Billing NPI |
| The following must be true:
|
Qualified Medicare Beneficiary (QMB) Status
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=R(Other or Additional Payor)benefitsInformation.insuranceTypeCode=QM(Qualified Medicare Beneficiary)
CWF field | JSON 271 eligibility response property | When to use |
Period From |
|
|
Period Through |
|
|
QMB Plan |
|
Medicare Secondary Payor
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=R(Other or Additional Payor)benefitsInformation.serviceTypeCodes=30(Health Benefit Plan Coverage)benefitsInformation.insuranceTypeCode=14,15,47, orWC
CWF field | JSON 271 eligibility response property | When to use |
Effective Date |
|
|
Termination Date |
|
|
Policy Number |
| |
Insurer |
| |
Address |
| |
Type |
|
Medicare Advantage
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=U(Contact Following Entity for Eligibility or Benefit Information)benefitsInformation.serviceTypeCodes=30(Health Benefit Plan Coverage) OR both30(Health Benefit Plan Coverage) ANDCQ(Case Management)benefitsInformation.insuranceTypeCode=HM(HMO),HN(HMO - Medicare Risk),IN(Indemnity),PR(PPO), orPS(POS)benefitsInformation.benefitsRelatedEntities.entityIdentifier=Primary Payer
CWF field | JSON 271 eligibility response property | When to use |
Effective Date |
|
|
Termination Date |
|
|
Plan Code |
| |
Payer Name |
| |
Address |
| |
Plan Name |
| |
Website |
| The following must be true:
In most cases, CMS only provides just the payer’s domain name, such as |
Phone Number |
| The following must be true:
|
Message(s) |
|
Part D
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=R(Other or Additional Payor)benefitsInformation.serviceTypeCodes=88(Pharmacy)
CWF field | JSON 271 eligibility response property | When to use |
Effective Date |
|
|
Termination Date |
|
|
Plan Code |
| |
Payer Name |
| |
Address |
| |
Plan Name |
| |
Website |
| The following must be true:
In most cases, CMS only provides just the payer’s domain name, such as |
Phone Number |
| The following must be true:
|
Therapy Caps
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=D(Benefit Description)benefitsInformation.serviceTypeCodes=AD(Occupational Therapy) orAE(Physical Medicine)
CWF field | JSON 271 eligibility response property | When to use |
Period Begin |
|
|
Period End |
|
|
PT/ST Applied |
| |
OT Applied |
|
Hospice
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=X(Health Care Facility)benefitsInformation.serviceTypeCodes=45(Hospice)
CWF field | JSON 271 eligibility response property | When to use |
Benefit Period | No direct mapping. Calculated by ordering the episodes by date for the calendar year. | |
Benefit Period Start Date |
|
|
Benefit Period End Date |
| benefitsInformation.benefitsDateInformation.benefit can be either a single date ( |
Provider |
| The following must be true:
|
Provider Name |
| The following must be true:
|
Hospice Elections | ||
Election Date |
|
|
Election Receipt Date |
| |
Election Revocation Date |
| |
Election Revocation Code |
| |
Election NPI |
| |
Home Health Certification
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=X(Health Care Facility)benefitsInformation.compositeMedicalProcedureIdentifier.procedureCode=G0180
CWF field | JSON 271 eligibility response property |
Certification HCPCS Code |
|
Process Date |
|
Rehabilitation Services
CWF field | JSON 271 eligibility response property | When to use |
Pulmonary Remaining (G0424) Technical |
| All of the following must be true:
|
Pulmonary Remaining (G0424) Professional |
| All of the following must be true:
|
Cardiac Applied (93797, 93798) Technical |
| All of the following must be true:
|
Cardiac Applied (93797, 93798) Professional |
| All of the following must be true:
|
Intensive Cardiac Applied (G0422, G0423) Technical |
| All of the following must be true:
|
Intensive Cardiac Applied (G0422, G0423) Professional |
| All of the following must be true:
|
Stedi’s Eligibility Check APIs let you get Medicare 271 eligibility responses as JSON. But your system – or one downstream – might need to display that JSON data in Common Working File (CWF) fields. Many providers still expect a CWF-style layout.
This guide shows how to map Stedi’s JSON 271 eligibility responses to CWF fields. It also covers what the CWF was, how Medicare eligibility checks work today, and why the CWF format still persists.
What Is the Common Working File (CWF)?
The Centers for Medicare & Medicaid Services (CMS) built the CWF in the 1980s to centrally manage Medicare eligibility. It was the source of truth for who was covered, when, and under which Medicare part.
The system produced fixed-format text files – also called “CWFs” – for mainframe terminals and printed reports. Each file had a set layout, with fields like member ID, coverage type, and benefit dates. For example:
How Medicare eligibility checks work today
CMS replaced the CWF in 2019 with the HIPAA Eligibility Transaction System (HETS). HETS returns standard 271 eligibility responses, the same as commercial insurers. Medicare 271s include a lot of Medicare-specific info, including:
Medicare Part A and Part B entitlements and dates
Part C (Medicare Advantage) and Part D (Prescription Drug) plan info
Deductibles, copays, and benefit limits
Remaining Skilled Nursing Facility (SNF) days
ESRD transplant or dialysis dates
Smoking cessation visits and therapy caps
Qualified Medicare Beneficiary (QMB), secondary payers, Medicaid crossover, and other coordination of benefits information.
In Stedi’s JSON 271 eligibility responses, that data lives under benefitsInformation. Each object describes a specific coverage, limit, or service type. For example:
{
...
"subscriber": {
"memberId": "123456789",
"firstName": "JANE",
"lastName": "DOE",
...
},
...
"benefitsInformation": [
{
"code": "B",
"name": "Co-Payment",
"serviceTypeCodes": ["30"],
"serviceTypes": ["Health Benefit Plan Coverage"],
"insuranceTypeCode": "MA",
"insuranceType": "Medicare Part A",
"timeQualifierCode": "7",
"timeQualifier": "Day",
"benefitAmount": "408",
"inPlanNetworkIndicatorCode": "W",
"inPlanNetworkIndicator": "Not Applicable",
"benefitsDateInformation": {
"admission": "20241231",
"admissions": [
{
"startDate": "20240101",
"endDate": "20241231"
}
]
},
"benefitsServiceDelivery": [
{
"unitForMeasurementCode": "Days",
"timePeriodQualifierCode": "30",
"timePeriodQualifier": "Exceeded",
"numOfPeriods": "60",
"unitForMeasurementQualifierCode": "DA",
"unitForMeasurementQualifier": "Days"
},
{
"unitForMeasurementCode": "Days",
"timePeriodQualifierCode": "31",
"timePeriodQualifier": "Not Exceeded",
"numOfPeriods": "90",
"unitForMeasurementQualifierCode": "DA",
"unitForMeasurementQualifier": "Days"
},
{
"timePeriodQualifierCode": "26",
"timePeriodQualifier": "Episode",
"numOfPeriods": "1"
}
]
}
]
}How to use this guide
Stedi’s JSON 271 eligibility response is easier to use in modern applications. But if your customers need the old CWF layout, you’ll need to map each field from JSON.
This guide isn’t an official spec. It’s a practical reference. Each section shows a CWF-style layout, a table of field mappings, and notes on when to use each field. For details on our JSON 271 eligibility responses, see our API documentation.
Provider information
CWF field | JSON 271 eligibility response property |
|---|---|
Organization Name |
|
NPI ID |
|
Patient Demographics
The following table includes patient demographics from the SUBMITTED TO PAYER and RETURNED BY PAYER sections of the sample CWF.
CWF field | JSON 271 eligibility response property | When to use |
|---|---|---|
SUBMITTED TO PAYER | ||
First Name |
| |
Last Name |
| |
Member ID (MBI) |
| |
D.O.B. |
| |
Eligibility Date(From) |
|
|
Eligibility Date(To) |
|
|
Service Types(s) |
| |
RETURNED TO PAYER | ||
First Name |
| |
Middle Name |
| |
Last Name |
| |
Suffix |
| |
Member ID (MBI) |
| |
D.O.B. |
| |
Gender |
| |
Address Line 1 |
| |
Address Line 2 |
| |
City |
| |
State |
| |
Zip Code |
| |
Benefit Information
In the JSON 271 eligibility response, benefitsInformation objects contain most of the benefits information.
The benefitsInformation.insuranceTypeCode property indicates the type of insurance policy within a program, such as Medicare. A code of MA indicates Medicare Part A. A code of MB indicates Medicare Part B. For a complete list of insurance type codes, see Insurance Type Codes in our docs.
The benefitsInformation.serviceTypeCodes property identifies the type of healthcare services the benefits information relates to. A service type code (STC) of 30 relates to general benefits information. For a complete list of STCs, see Service Type Codes in our docs.
CWF field | JSON 271 eligibility response property | When to use |
|---|---|---|
Effective Date |
| All of the following must be true:
|
Termination Date |
| All of the following must be true:
|
Ineligible Start |
| All of the following must be true:
|
Ineligible End |
| All of the following must be true:
|
Date of Death |
| |
Lifetime Psychiatric Days |
| All of the following must be true:
|
Lifetime Reserve Days |
| All of the following must be true:
|
Smoking Cessation Days |
| All of the following must be true:
|
Initial Cessation Date |
| This information is only available if an initial counseling visit was used in the past 12 months. All of the following must be true:
|
ESRD Dialysis Date |
| All of the following must be true:
|
ESRD Transplant Date |
| All of the following must be true:
|
ESRD Coverage Period |
| All of the following must be true:
|
Plan Benefits
CWF field | JSON 271 eligibility response property | When to use |
|---|---|---|
Medicare Part A | ||
Type | Use Base when all of the following are true:
Use Spell when all of the following are true:
| |
First Bill |
| |
Last Bill |
| |
Hospital Days Full | For a Type of Base, use For a Type of Base, use | |
Hospital Days Colns | For a Type of Base, use
For a Type of Base, use
| |
Hospital Days Base |
| |
SNF Days Full |
| All of the following must be true:
|
SNF Days Colns |
| All of the following must be true:
|
SNF Days Base |
| All of the following must be true:
|
Inpatient Deductible |
| All of the following must be true:
|
Medicare Part B | ||
Deductible Remaining |
| All of the following must be true:
|
Physical Therapy |
| All of the following must be true:
|
Occupational Therapy |
| All of the following must be true:
|
Blood Pints Part A/B |
| All of the following must be true:
|
Medicare Part A Stays | ||
Type | Use Hospital when:
Use Hospital Stay when:
Use SNF Stay when:
| The following must be true:
|
Start Date |
|
|
End Date |
|
|
Billing NPI |
| The following must be true:
|
Qualified Medicare Beneficiary (QMB) Status
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=R(Other or Additional Payor)benefitsInformation.insuranceTypeCode=QM(Qualified Medicare Beneficiary)
CWF field | JSON 271 eligibility response property | When to use |
Period From |
|
|
Period Through |
|
|
QMB Plan |
|
Medicare Secondary Payor
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=R(Other or Additional Payor)benefitsInformation.serviceTypeCodes=30(Health Benefit Plan Coverage)benefitsInformation.insuranceTypeCode=14,15,47, orWC
CWF field | JSON 271 eligibility response property | When to use |
Effective Date |
|
|
Termination Date |
|
|
Policy Number |
| |
Insurer |
| |
Address |
| |
Type |
|
Medicare Advantage
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=U(Contact Following Entity for Eligibility or Benefit Information)benefitsInformation.serviceTypeCodes=30(Health Benefit Plan Coverage) OR both30(Health Benefit Plan Coverage) ANDCQ(Case Management)benefitsInformation.insuranceTypeCode=HM(HMO),HN(HMO - Medicare Risk),IN(Indemnity),PR(PPO), orPS(POS)benefitsInformation.benefitsRelatedEntities.entityIdentifier=Primary Payer
CWF field | JSON 271 eligibility response property | When to use |
Effective Date |
|
|
Termination Date |
|
|
Plan Code |
| |
Payer Name |
| |
Address |
| |
Plan Name |
| |
Website |
| The following must be true:
In most cases, CMS only provides just the payer’s domain name, such as |
Phone Number |
| The following must be true:
|
Message(s) |
|
Part D
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=R(Other or Additional Payor)benefitsInformation.serviceTypeCodes=88(Pharmacy)
CWF field | JSON 271 eligibility response property | When to use |
Effective Date |
|
|
Termination Date |
|
|
Plan Code |
| |
Payer Name |
| |
Address |
| |
Plan Name |
| |
Website |
| The following must be true:
In most cases, CMS only provides just the payer’s domain name, such as |
Phone Number |
| The following must be true:
|
Therapy Caps
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=D(Benefit Description)benefitsInformation.serviceTypeCodes=AD(Occupational Therapy) orAE(Physical Medicine)
CWF field | JSON 271 eligibility response property | When to use |
Period Begin |
|
|
Period End |
|
|
PT/ST Applied |
| |
OT Applied |
|
Hospice
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=X(Health Care Facility)benefitsInformation.serviceTypeCodes=45(Hospice)
CWF field | JSON 271 eligibility response property | When to use |
Benefit Period | No direct mapping. Calculated by ordering the episodes by date for the calendar year. | |
Benefit Period Start Date |
|
|
Benefit Period End Date |
| benefitsInformation.benefitsDateInformation.benefit can be either a single date ( |
Provider |
| The following must be true:
|
Provider Name |
| The following must be true:
|
Hospice Elections | ||
Election Date |
|
|
Election Receipt Date |
| |
Election Revocation Date |
| |
Election Revocation Code |
| |
Election NPI |
| |
Home Health Certification
In the JSON 271 eligibility response, this information is only available when all of the following is true:
benefitsInformation.code=X(Health Care Facility)benefitsInformation.compositeMedicalProcedureIdentifier.procedureCode=G0180
CWF field | JSON 271 eligibility response property |
Certification HCPCS Code |
|
Process Date |
|
Rehabilitation Services
CWF field | JSON 271 eligibility response property | When to use |
Pulmonary Remaining (G0424) Technical |
| All of the following must be true:
|
Pulmonary Remaining (G0424) Professional |
| All of the following must be true:
|
Cardiac Applied (93797, 93798) Technical |
| All of the following must be true:
|
Cardiac Applied (93797, 93798) Professional |
| All of the following must be true:
|
Intensive Cardiac Applied (G0422, G0423) Technical |
| All of the following must be true:
|
Intensive Cardiac Applied (G0422, G0423) Professional |
| All of the following must be true:
|
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Stedi is a registered trademark of Stedi, Inc. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.
Get updates on what’s new at Stedi
Backed by
Stedi is a registered trademark of Stedi, Inc. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.
Get updates on what’s new at Stedi
Backed by
Stedi is a registered trademark of Stedi, Inc. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.