270 - Eligibility, Coverage or Benefit Inquiry

FUNCTIONAL GROUP=HS

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.

SCHEMA

ST

Segment	Name	Position
ST	Transaction Set Header	0100
BHT	Beginning of Hierarchical Transaction	0200

2000

Segment	Name	Position
HL	Hierarchical Level	0100
TRN	Trace	0200

2100

Segment	Name	Position
NM1	Individual or Organizational Name	0300
REF	Reference Information	0400
N2	Additional Name Information	0500
N3	Party Location	0600
N4	Geographic Location	0700
PER	Administrative Communications Contact	0800
PRV	Provider Information	0900
DMG	Demographic Information	1000
INS	Insured Benefit	1100
HI	Health Care Information Codes	1150
DTP	Date or Time or Period	1200
MPI	Military Personnel Information	1250

2110

Segment	Name	Position
EQ	Eligibility or Benefit Inquiry	1300
AMT	Monetary Amount Information	1350
VEH	Vehicle Information	1400
PDR	Property Description - Real	1500
PDP	Property Description - Personal	1600
III	Information	1700
REF	Reference Information	1900
DTP	Date or Time or Period	2000
SE	Transaction Set Trailer	2100

COMMENTS

Notes
2/0200	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.

rev 29/11/2024