270 Eligibility, Coverage or Benefit Inquiry
Functional Group HS
X12N Insurance Subcommittee
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.
Heading
Position
Segment
Name
Max use
0100
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
0200
Beginning of Hierarchical TransactionMandatory
Max 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
Position
Segment
Name
Max use
2000 Loop
Repeat >1
0100
Hierarchical LevelMandatory
Max 1
To identify dependencies among and the content of hierarchically related groups of data segments
0200
TraceOptional
Max 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
Repeat >1
0300
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
0400
Reference InformationOptional
Max 9
To specify identifying information
0500
Additional Name InformationOptional
Max 1
To specify additional names
0600
Party LocationOptional
Max 1
To specify the location of the named party
0700
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
0800
Administrative Communications ContactOptional
Max 3
To identify a person or office to whom administrative communications should be directed
0900
Provider InformationOptional
Max 1
To specify the identifying characteristics of a provider
1000
Demographic InformationOptional
Max 1
To supply demographic information
1100
Insured BenefitOptional
Max 1
To provide benefit, characteristics, and identification information on insured entities.
1150
Health Care Information CodesOptional
Max 1
To supply information related to the delivery of health care
1200
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
1250
Military Personnel InformationOptional
Max 9
To report military service data
2110 Loop
Repeat 99
1300
Eligibility or Benefit InquiryMandatory
Max 1
To specify inquired eligibility or benefit information
1350
Monetary Amount InformationOptional
Max 2
To indicate the total monetary amount
1400
Vehicle InformationOptional
Max 1
To provide descriptions that identify a specific vehicle
1500
Property Description - RealOptional
Max 1
To provide a description of real property
1600
Property Description - PersonalOptional
Max 1
To provide a description of personal property
1700
InformationOptional
Max 10
To report information
1900
Reference InformationOptional
Max 1
To specify identifying information
2000
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
2050
Tooth IdentificationOptional
Max >1
To identify a tooth by number and, if applicable, one or more tooth surfaces
2100
Transaction Set TrailerMandatory
Max 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)