Healthcare
20 columns
110 rows
8 formats

Eligibility and Benefits Verification

This dataset provides granular, real-time details on patient insurance eligibility and benefits, including coverage status, effective dates, deductibles, copays, prior authorization requirements, and benefit limitations as transmitted via 270/271 EDI transactions. It is ideal for healthcare providers, payers, and revenue cycle teams seeking to streamline eligibility checks, prevent claim denials, and optimize patient financial counseling.

last updated 2 Nov 2025
by GoMask

The brief that made it

Automated insurance eligibility verification for patient intake

Sample rows

preview · 8 of 110 rows · all 20 columns

transaction_idstring	coverage_typestring	coinsurance_percentagefloat	prior_authorization_requiredboolean	benefit_limit_typestring	patient_idstring	payer_idstring	provider_idstring	coverage_statusstring	coverage_effective_datedate	coverage_end_datedate	deductible_met_amountfloat	deductible_total_amountfloat	copay_amountfloat	benefit_limit_valuefloat	service_type_codestring	service_type_descriptionstring	transaction_datetimedatetime	response_codestring	response_messagestring
TRX00001	medical	20	false	annual	PAT0001	PYR1001	PRV2001	active	2023-03-18	blank	185.23	1200	25	10000	30	Health Benefit Plan Coverage	2024-04-11T09:46:00	approved	Eligibility and benefits confirmed for medical coverage. Annual limit is $10,000.
TRX00002	dental	15	false	visit	PAT0002	PYR1002	PRV2002	active	2022-09-03	blank	60.5	200	45	8	35	Routine Dental	2024-02-21T14:20:00	approved	Dental coverage active. Visit limit is 8/year.
TRX00003	pharmacy	0	false	dollar	PAT0003	PYR1003	PRV2003	terminated	2022-04-01	2023-11-15	75	75	0	15000	48	Pharmacy Coverage	2024-01-05T10:32:00	denied	Coverage terminated as of 2023-11-15. No pharmacy benefits available.
TRX00004	medical	10	true	dollar	PAT0004	PYR1004	PRV2004	pending	2024-04-02	blank	0	1800	35	20000	30	Specialist Visit	2024-04-10T11:04:00	pending	Prior authorization required for coverage activation. Authorization details sent to provider.
TRX00005	vision	0	false	annual	PAT0005	PYR1005	PRV2005	active	2021-06-25	blank	15	75	20	300	47	Vision Exam	2024-03-19T15:18:00	approved	Vision benefits confirmed. Annual limit is $300.
TRX00006	other	100	true	other	PAT0006	PYR1001	PRV2001	inactive	2020-01-10	2023-06-01	0	0	0	1	99	Other Coverage Type	2024-02-10T13:00:00	error	Coverage is inactive. Prior authorization required for legacy services.
TRX00007	dental	20	false	visit	PAT0007	PYR1002	PRV2002	active	2023-10-14	blank	120	250	60	10	35	Preventive Dental	2024-04-09T10:20:00	approved	Dental coverage confirmed. Preventive services up to 10 visits.
TRX00008	pharmacy	5	false	dollar	PAT0008	PYR1003	PRV2003	active	2022-05-30	blank	10	50	7.5	5000	48	Pharmacy Benefits	2024-03-15T17:12:00	approved	Pharmacy coverage active. Annual dollar limit is $5,000.
TRX00009	vision	0	true	visit	PAT0009	PYR1004	PRV2004	pending	2024-04-05	blank	0	40	18	2	47	Contact Lens	2024-04-10T16:55:00	pending	Prior authorization required for vision coverage. Contact lens fitting to be reviewed.
TRX00010	medical	15	false	annual	PAT0010	PYR1005	PRV2005	active	2022-12-15	blank	900	900	30	15000	30	Emergency Room	2024-04-09T08:51:00	approved	Eligibility confirmed. Deductible fully met for coverage period.
TRX00011	vision	0	false	annual	PAT0011	PYR1001	PRV2001	terminated	2021-09-10	2023-12-31	50	75	0	200	47	Vision Hardware	2024-02-15T12:43:00	denied	Vision benefits terminated as of 2023-12-31. No active coverage.
TRX00012	dental	0	false	lifetime	PAT0012	PYR1002	PRV2002	inactive	2021-04-11	2023-04-30	0	0	0	3000	35	Orthodontic Care	2024-01-21T10:38:00	denied	Dental coverage inactive. Lifetime benefit limit reached.
TRX00013	pharmacy	20	true	dollar	PAT0013	PYR1003	PRV2003	pending	2024-04-07	blank	0	20	2.5	7500	48	High-cost Drug Coverage	2024-04-10T18:10:00	pending	Prior authorization required for pharmacy coverage. Awaiting approval.
TRX00014	vision	0	false	visit	PAT0014	PYR1004	PRV2004	active	2022-03-21	blank	5	60	22	3	47	Vision Exam	2024-03-28T09:12:00	approved	Vision coverage active. 3 visits allowed per year.
TRX00015	medical	20	false	annual	PAT0015	PYR1005	PRV2005	active	2023-02-02	blank	420	1000	30	12000	30	Health Benefit Plan Coverage	2024-04-06T13:47:00	approved	Medical coverage confirmed. Annual deductible met: $420/$1000.
TRX00016	other	100	true	other	PAT0016	PYR1001	PRV2001	terminated	2019-07-19	2022-08-05	0	0	0	999999.99	99	Genetic Counseling	2024-03-02T11:00:00	error	Coverage terminated. Authorization required for special program.
TRX00017	pharmacy	10	false	dollar	PAT0017	PYR1002	PRV2002	active	2023-07-10	blank	50	60	9	12000	48	Pharmacy Coverage	2024-03-15T09:24:00	approved	Pharmacy benefits confirmed. Deductible met: $50/$60.
TRX00018	dental	0	false	lifetime	PAT0018	PYR1003	PRV2003	active	2021-11-30	blank	35	150	20	4000	35	Preventive Dental	2024-02-25T13:51:00	approved	Dental benefits active. Lifetime benefit limit applies.
TRX00019	other	100	true	other	PAT0019	PYR1004	PRV2004	pending	2024-04-09	blank	0	0	0	10	99	Alternative Therapy	2024-04-10T12:19:00	pending	Authorization required for coverage of Alternative Therapy services.
TRX00020	medical	15	false	annual	PAT0020	PYR1005	PRV2005	active	2022-07-01	blank	700	1500	27	12000	30	Health Benefit Plan Coverage	2024-03-18T10:48:00	approved	Medical coverage confirmed. Annual limit: $12,000.

What the 110 rows show

from the 110-row sample

Other (coverage type) stands out: mean coinsurance_percentage is 100.0, against 7.9 for the rest.

28%prior_authorization_required = true
10median coinsurance_percentage
4coverage statuses
4response codes
5service type codes
18service type descriptions

Mean coinsurance_percentage by coverage_type110 rows

coinsurance_percentage110 rows, in bands of 10

Median 10, from 0 to 100.

benefit_limit_type104 rows with a value · 6 left blank

annual32
visit22
dollar22
other15
lifetime13

20 columns by typefrom the column list below

string 11
float 5
date 2
datetime 1
boolean 1

Columns

20 columns in four groups

blueprint · 20 columns
column	type	description	example
Text 11 columns
`transaction_id`	string	Unique identifier for the eligibility verification transaction (270/271 EDI).unique	TRX00001
`patient_id`	string	Unique identifier for the patient whose eligibility is being checked.	PAT0001
`payer_id`	string	Unique identifier for the insurance payer.	PYR1001
`provider_id`	string	Unique identifier for the healthcare provider submitting the eligibility check.	PRV2001
`coverage_status`	string	Current coverage status for the patient (e.g., active, inactive, terminated, pending).active · inactive · terminated · pending	active
`coverage_type`	string	Type of insurance coverage (e.g., medical, dental, vision, pharmacy).medical · dental · vision · pharmacy · other	medical
`benefit_limit_type`	string	Type of benefit limitation (e.g., annual, lifetime, visit, dollar).annual · lifetime · visit · dollar · other · optional	annual
`service_type_code`	string	Standard code indicating the type of service (e.g., 30 for health benefit plan coverage).5 codes · optional	30
`service_type_description`	string	Description of the service type covered.optional	Routine Dental
`response_code`	string	Code indicating the outcome of the eligibility check (e.g., approved, denied, error).approved · denied · error · pending	approved
`response_message`	string	Detailed message or notes returned from the payer regarding eligibility or benefits.optional	Eligibility and benefits …
Numbers 5 columns
`deductible_met_amount`	float	Amount of deductible that has been met by the patient for the coverage period.0 or more · optional	185.23
`deductible_total_amount`	float	Total deductible amount required for the coverage period.0 or more · optional	1200
`copay_amount`	float	Copay amount required for the covered service.0 or more · optional	25
`coinsurance_percentage`	float	Percentage of coinsurance required for the covered service.0 to 100 · optional	20
`benefit_limit_value`	float	Value of the benefit limitation (e.g., number of visits, dollar amount).0 or more · optional	10000
Dates and times 3 columns
`coverage_effective_date`	date	Date when the coverage became effective.	2023-03-18
`coverage_end_date`	date	Date when the coverage ends or ended (if applicable).optional	2023-11-15
`transaction_datetime`	datetime	Date and time when the eligibility check transaction occurred.	2024-04-11T09:46:00
True or false 1 column
`prior_authorization_required`	boolean	Indicates if prior authorization is required for the service.	false

Use it for

A healthcare dashboard
The prior_authorization_required rate, coinsurance_percentage by coverage_type and a breakdown of benefit_limit_type. Excel, Power BI or Tableau.
Why do the 15 other rows have a mean coinsurance_percentage of 100.0?
A root-cause class exercise
Hand out the rows and one question. The answer is in the data, not in the brief.
Transactions110
TRX0000120medical
TRX0000410medical
TRX00006100other
A software demo
Believable transactions with patient_id, payer_id and provider_id to fill a screen in front of a buyer.

This dataset110 rows20 columns

Yours10,000 rows20 columns

blueprint · eligibility-and-benefits-verification

Behind this dataset

Same schema. As many rows as you need.

These 110 rows came out of a blueprint — 20 columns with generation rules behind each one. Open it in Data Factory to retune a column, add your own, wire in foreign keys, and run it at the size you actually need.

Rules it was built with

270 EDI transaction: eligibility inquiry
271 EDI transaction: eligibility response
Patient identifier: member ID, SSN, DOB
Subscriber vs dependent relationship
Coverage status: active, inactive, terminated
Effective date and termination date
Plan type: HMO, PPO, EPO, POS, HDHP
Deductible: individual and family amounts, remaining

Rows1,000 rows10,000 rows100,000 rows1,000,000 rows

Open the blueprint in Data Factory

1 credit per row. New accounts start with 25 free credits.

Exports: CSV, JSON, JSONL, Parquet, SQL, Excel, TSV, XML
Licence: yours to use, including commercially
API slug: eligibility-and-benefits-verification

What should your data show?

No signup. No card.

Sample rows

What the 110 rows show

Columns

Use it for

A healthcare dashboard

A root-cause class exercise

A software demo

Make it yours.

Same schema. As many rows as you need.

More in Healthcare

What should your data show?