Health Care Eligibility Benefit Inquiry (X279A1)

ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *231103*0214*^*00501*000000001*0*T*>~
GS*HS*SENDERGS*RECEIVERGS*20231103*021433*000000001*X*005010X279A1~
ST*270*1234*005010X279A1~
BHT*0022*13*10001234*20060501*1319~
HL*1**20*1~
NM1*PR*2*SECURITY HEALTH PLAN*****PI*SHP~
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       *231103*0214*^*00501*000000001*0*T*>~
GS*HS*SENDERGS*RECEIVERGS*20231103*021448*000000001*X*005010X279A1~
ST*270*1235*005010X279A1~
BHT*0022*13*10001235*20060501*1320~
HL*1**20*1~
NM1*PR*2*SECURITY HEALTH PLAN*****PI*SHP~
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~

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X12 270 Health Care Eligibility Benefit Inquiry (X279A1)