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Transaction Set
in
X12 Release 008020

270 Eligibility, Coverage or Benefit Inquiry

Functional Group HS

X12N Insurance Subcommittee

This X12 Transaction Set 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
0100
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
0200
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
0100
Hierarchical LevelMandatory
Max 1
To identify dependencies among and the content of hierarchically related groups of data segments
0200
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
0300
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
0400
Reference Information
Max 9
To specify identifying information
0500
Additional Name Information
Max 1
To specify additional names
0600
Party Location
Max 1
To specify the location of the named party
0700
Geographic Location
Max 1
To specify the geographic place of the named party
0800
Administrative Communications Contact
Max 3
To identify a person or office to whom administrative communications should be directed
0900
Provider Information
Max 1
To specify the identifying characteristics of a provider
1000
Demographic Information
Max 1
To supply demographic information
1100
Insured Benefit
Max 1
To provide benefit, characteristics, and identification information on insured entities.
1150
Health Care Information Codes
Max 1
To supply information related to the delivery of health care
1200
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
1250
Military Personnel Information
Max 9
To report military service data
2110 Loop
Repeat 99
1300
Eligibility or Benefit Inquiry
Max 1
To specify inquired eligibility or benefit information
1350
Monetary Amount Information
Max 2
To indicate the total monetary amount
1400
Vehicle Information
Max 1
To provide descriptions that identify a specific vehicle
1500
Property Description - Real
Max 1
To provide a description of real property
1600
Property Description - Personal
Max 1
To provide a description of personal property
1700
Information
Max 10
To report information
1900
Reference Information
Max 1
To specify identifying information
2000
Date or Time or Period
Max 9
To specify any or all of a date, a time, or a time period
2050
Tooth Identification
Max >1
To identify a tooth by number and, if applicable, one or more tooth surfaces
2100
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.