EDI 270 Eligibility%2c Coverage Or Benefit Inquiry

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.

Segments

Position

Segment

Name

Max use

100

Transaction Set Header

Mandatory

AtMax 1

To indicate the start of a transaction set and to assign a control number

200

BHT

Beginning of Hierarchical Transaction

Mandatory

AtMax 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

2000

LOOP

Mandatory

GT 1

100

Hierarchical Level

Mandatory

AtMax 1

To identify dependencies among and the content of hierarchically related groups of data segments

200

TRN

Trace

Opt

AtMax 9

To uniquely identify a transaction to an application

2100

LOOP

Mandatory

GT 1

300

NM1

Individual or Organizational Name

Mandatory

AtMax 1

To supply the full name of an individual or organizational entity

400

REF

Reference Information

Opt

AtMax 9

To specify identifying information

500

Additional Name Information

Opt

AtMax 1

To specify additional names

600

Party Location

Opt

AtMax 1

To specify the location of the named party

700

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

800

PER

Administrative Communications Contact

Opt

AtMax 3

To identify a person or office to whom administrative communications should be directed

900

PRV

Provider Information

Opt

AtMax 1

To specify the identifying characteristics of a provider

1000

DMG

Demographic Information

Opt

AtMax 1

To supply demographic information

1100

INS

Insured Benefit

Opt

AtMax 1

To provide benefit, characteristics, and identification information on insured entities.

1150

Health Care Information Codes

Opt

AtMax 1

To supply information related to the delivery of health care

1200

DTP

Date or Time or Period

Opt

AtMax 9

To specify any or all of a date, a time, or a time period

1250

MPI

Military Personnel Information

Opt

AtMax 9

To report military service data

2110

LOOP

Opt

AtMax 99

1300

Eligibility or Benefit Inquiry

Opt

AtMax 1

To specify inquired eligibility or benefit information

1350

AMT

Monetary Amount Information

Opt

AtMax 2

To indicate the total monetary amount

1400

VEH

Vehicle Information

Opt

AtMax 1

To provide descriptions that identify a specific vehicle

1500

PDR

Property Description - Real

Opt

AtMax 1

To provide a description of real property

1600

PDP

Property Description - Personal

Opt

AtMax 1

To provide a description of personal property

1700

III

Information

Opt

AtMax 10

To report information

1900

REF

Reference Information

Opt

AtMax 1

To specify identifying information

2000

DTP

Date or Time or Period

Opt

AtMax 9

To specify any or all of a date, a time, or a time period

2050

TOO

Tooth Identification

Opt

GT 1

To identify a tooth by number and, if applicable, one or more tooth surfaces

2100

Transaction Set Trailer

Mandatory

AtMax 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)

Elements

Position	Element	Name	Requirement	Type	Min/Max	Repeat

1	143	Transaction Set Identifier Code	Mandatory	ID	3/3	1

2	329	Transaction Set Control Number	Mandatory	Alphanumeric	4/9	1

3	1705	Implementation Convention Reference	Opt	Alphanumeric	1/35	1

EDI Dictionary

EDI 270 Eligibility%2c Coverage Or Benefit Inquiry

Segments

Elements