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Transaction Set
in
X12 Release 004010

270 Eligibility, Coverage or Benefit Inquiry

Functional Group HS

This Draft Standard for Trial Use contains the format and establishes the data contents of the Eligibility, Coverage or Benefit Inquiry Transaction Set (270) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to inquire about the eligibility, coverages or benefits associated with a benefit plan, employer, plan sponsor, subscriber or a dependent under the subscriber's policy. The transaction set is intended to be used by all lines of insurance such as Health, Life, and Property and Casualty.

Heading

Sequence
Segment
Name
Max use
010
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
020
Beginning of Hierarchical TransactionMandatory
Max 1
To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time

Detail

Sequence
Segment
Name
Max use
2000 Loop
Repeat >1
010
Hierarchical LevelMandatory
Max 1
To identify dependencies among and the content of hierarchically related groups of data segments
020
Trace
Max 9
To uniquely identify a transaction to an application
If the Eligibility, Coverage or Benefit Inquiry Transaction Set (270) includes a TRN segment, then the Eligibility, Coverage or Benefit Information Transaction Set (271) must return the trace number identified in the TRN segment.
2100 Loop
Repeat >1
030
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
040
Reference Identification
Max 9
To specify identifying information
050
Additional Name Information
Max 1
To specify additional names or those longer than 35 characters in length
060
Address Information
Max 1
To specify the location of the named party
070
Geographic Location
Max 1
To specify the geographic place of the named party
080
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be directed
090
Provider Information
Max 1
To specify the identifying characteristics of a provider
100
Demographic Information
Max 1
To supply demographic information
110
Insured Benefit
Max 1
To provide benefit information on insured entities
120
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
2110 Loop
Repeat 99
130
Eligibility or Benefit Inquiry
Max 1
To specify inquired eligibility or benefit information
135
Monetary Amount
Max 2
To indicate the total monetary amount
140
Vehicle Information
Max 1
To provide descriptions that identify a specific vehicle
150
Property Description - Real
Max 1
To provide a description of real property
160
Property Description - Personal
Max 1
To provide a description of personal property
170
Information
Max 10
To report information
190
Reference Identification
Max 1
To specify identifying information
200
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
210
Transaction Set TrailerMandatory
Max 1
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. 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.
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. 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.