EDI 270 Eligibility, Coverage or Benefit Inquiry
Functional Group HS
X12N Insurance Subcommittee
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
- 0100Transaction Set HeaderMandatoryMax 1
To indicate the start of a transaction set and to assign a control number
- 0200Beginning of Hierarchical TransactionMandatoryMax 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
- 2000 Loop MandatoryRepeat >1
- 0100Hierarchical LevelMandatoryMax 1
To identify dependencies among and the content of hierarchically related groups of data segments
- 0200TraceOptionalMax 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 MandatoryRepeat >1
- 0300Individual or Organizational NameMandatoryMax 1
To supply the full name of an individual or organizational entity
- 0400Reference IdentificationOptionalMax 9
To specify identifying information
- 0500Additional Name InformationOptionalMax 1
To specify additional names
- 0600Address InformationOptionalMax 1
To specify the location of the named party
- 0700Geographic LocationOptionalMax 1
To specify the geographic place of the named party
- 0800Administrative Communications ContactOptionalMax 3
To identify a person or office to whom administrative communications should be directed
- 0900Provider InformationOptionalMax 1
To specify the identifying characteristics of a provider
- 1000Demographic InformationOptionalMax 1
To supply demographic information
- 1100Insured BenefitOptionalMax 1
To provide benefit information on insured entities
- 1200Date or Time or PeriodOptionalMax 9
To specify any or all of a date, a time, or a time period
- 2110 Loop OptionalRepeat 99
- 1300Eligibility or Benefit InquiryMandatoryMax 1
To specify inquired eligibility or benefit information
- 1350Monetary AmountOptionalMax 2
To indicate the total monetary amount
- 1400Vehicle InformationOptionalMax 1
To provide descriptions that identify a specific vehicle
- 1500Property Description - RealOptionalMax 1
To provide a description of real property
- 1600Property Description - PersonalOptionalMax 1
To provide a description of personal property
- 1700InformationOptionalMax 10
To report information
- 1900Reference IdentificationOptionalMax 1
To specify identifying information
- 2000Date or Time or PeriodOptionalMax 9
To specify any or all of a date, a time, or a time period
- 1300Eligibility or Benefit InquiryMandatoryMax 1
- 0300Individual or Organizational NameMandatoryMax 1
- 0100Hierarchical LevelMandatoryMax 1
- 2100Transaction Set TrailerMandatoryMax 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)