Health Care Eligibility Benefit Inquiry (X279A1)

Eligibility, Coverage or Benefit Inquiry (270)

No Authorization Information Present (No Meaningful Information in I02)

Standards Approved for Publication by ASC X12 Procedures Review Board through October 2003

No Security Information Present (No Meaningful Information in I04)

ST*270*1234*005010X279A1~
BHT*0022*13*10001234*20060501*1319~
HL*1**20*1~
NM1*PR*2*ABC COMPANY*****PI*040~
HL*2*1*21*1~
NM1*1P*2*BONE AND JOINT CLINIC*****SV*2000035~
HL*3*2*22*0~
TRN*1*93175-012547*9877281234~
NM1*IL*1*SMITH*ROBERT****MI*11122333301~
DMG*D8*19430519~
DTP*291*D8*20060501~
EQ*30~
SE*13*1234~


Example 1: Generic Request By a Clinic for the Patient’s (Subscriber) Eligibility

ST*270*1235*005010X279A1~
BHT*0022*13*10001235*20060501*1320~
HL*1**20*1~
NM1*PR*2*ABC COMPANY*****PI*040~
HL*2*1*21*1~
NM1*1P*1*JONES*MARCUS****SV*0202034~
HL*3*2*22*1~
NM1*IL*1******MI*11122333301~
HL*4*3*23*0~
TRN*1*93175-012547*9877281234~
NM1*03*1*SMITH*MARY~
DMG*D8*19781014~
DTP*291*D8*20060501~
EQ*30~
SE*15*1235~


X12 270 Health Care Eligibility Benefit Inquiry (X279A1)