Health Care Eligibility Benefit Inquiry (X279A1)

ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *231106*1406*^*00501*000000001*0*T*>~
GS*HS*SENDERGS*RECEIVERGS*20231106*140631*000000001*X*005010X279A1~
ST*270*1234*005010X279A1~
BHT*0022*13*10001234*20060501*1319~
HL*1**20*1~
NM1*PR*2*ABC COMPANY*****PI*842610001~
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~
GE*1*000000001~
IEA*1*000000001~

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

ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *231106*1406*^*00501*000000001*0*T*>~
GS*HS*SENDERGS*RECEIVERGS*20231106*140642*000000001*X*005010X279A1~
ST*270*1235*005010X279A1~
BHT*0022*13*10001235*20060501*1320~
HL*1**20*1~
NM1*PR*2*ABC COMPANY*****PI*842610001~
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~
GE*1*000000001~
IEA*1*000000001~

Example 2: Generic Request by a Physician for the Patient’s (Dependent) Eligibility

ISA*00*          *00*          *ZZ*COMPANYNAME    *ZZ*GUIDENAME      *041227*1324*^*00501*000000103*0*P*>~
GS*HS*COMPANYNAME*GUIDENAME*20041227*1324*000000103*X*005010X279A1~
ST*270*1234*005010X279A1~
BHT*0022*13*10001234*20060501*1319~
HL*1**20*1~
NM1*PR*2*ABC COMPANY*****PI*842610001~
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~
GE*1*000000103~
IEA*1*000000103~

X12 270 Health Care Eligibility Benefit Inquiry (X279A1)