X12 HIPAA 270 Generic Request

The EDI 270 Health Care Eligibility/Benefit Inquiry transaction set is used to request information from a healthcare insurance plan about a policy’s coverages, typically in relation to a particular plan subscriber. This transaction is typically sent by healthcare service providers, such as hospitals or medical facilities, and sent to insurance companies, government agencies like Medicare or Medicaid, or other organizations that would have information about a given policy.

The 270 transaction is used for inquiries about what services are covered for particular patients (policy subscribers or their dependents), including required copay or coinsurance. It may be used to inquire about general information on coverage and benefits. It may also be used for questions about the coverage of specific benefits for a given plan, such as wheelchair rental, diagnostic lab services, physical therapy services, etc. The 270 document typically includes the following:

• Details of the sender of the inquiry (name and contact information of the information receiver)
• Name of the recipient of the inquiry (the information source)
• Details of the plan subscriber about to the inquiry is referring
• Description of eligibility or benefit information requested

The 270 transaction is used in conjunction with the EDI 271 transaction. The 271 is the Health Care Eligibility/Benefit Response and is used to transmit the information requested in a 270. Healthcare providers used to contact insurance companies by phone to verify patient coverage for services, which limited the information exchange to simple yes/no questions.

X12 HIPAA 270 Specification

X12 HIPAA 270 specification is available at:

• EdiNation

X12 HIPAA 270 Code Example

X12 HIPAA 270 code example is available at:

• EDI Tools for .NET X12 HIPAA 270 parse & generate C# example

X12 HIPAA 270 Sample File

ISA*00*          *00*          *ZZ*1234567        *ZZ*11111          *170508*1141*^*00501*000000101*1*P*:~
GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X279A1~
ST*270*1234*005010X279A1~
BHT*0022*13*10001234*20060501*1319~
HL*1**20*1~
NM1*PR*2*ABC COMPANY*****PI*842610001~
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*101~
IEA*1*000000101~