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270Eligibility, Coverage or Benefit Inquiry

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.

  • ST
    Transaction Set Header
    M必须(Mandatory)
    Repeat 1

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

  • BHT
    Beginning of Hierarchical Transaction
    M必须(Mandatory)
    Repeat 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

  • HLLoop1Hierarchical Level LOOPM必须(Mandatory)Repeat > 1
    HLTRNNM1Loop1
    • HL
      Hierarchical Level
      M必须(Mandatory)
      Repeat 1

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

    • TRN
      Trace
      O可选(Optional)
      Repeat 9

      To uniquely identify a transaction to an application

    • NM1Loop1Individual or Organizational Name LOOPM必须(Mandatory)Repeat > 1
      NM1REFN2N3N4PERPRVDMGINSDTPEQLoop1
      • NM1
        Individual or Organizational Name
        M必须(Mandatory)
        Repeat 1

        To supply the full name of an individual or organizational entity

      • REF
        Reference Identification
        O可选(Optional)
        Repeat 9

        To specify identifying information

      • N2
        Additional Name Information
        O可选(Optional)
        Repeat 1

        To specify additional names

      • N3
        Address Information
        O可选(Optional)
        Repeat 1

        To specify the location of the named party

      • N4
        Geographic Location
        O可选(Optional)
        Repeat 1

        To specify the geographic place of the named party

      • PER
        Administrative Communications Contact
        O可选(Optional)
        Repeat 3

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

      • PRV
        Provider Information
        O可选(Optional)
        Repeat 1

        To specify the identifying characteristics of a provider

      • DMG
        Demographic Information
        O可选(Optional)
        Repeat 1

        To supply demographic information

      • INS
        Insured Benefit
        O可选(Optional)
        Repeat 1

        To provide benefit information on insured entities

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat 9

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

      • EQLoop1Eligibility or Benefit Inquiry LOOPO可选(Optional)Repeat 99
        EQAMTVEHPDRPDPIIIREFDTP
        • EQ
          Eligibility or Benefit Inquiry
          M必须(Mandatory)
          Repeat 1

          To specify inquired eligibility or benefit information

        • AMT
          Monetary Amount
          O可选(Optional)
          Repeat 2

          To indicate the total monetary amount

        • VEH
          Vehicle Information
          O可选(Optional)
          Repeat 1

          To provide descriptions that identify a specific vehicle

        • PDR
          Property Description - Real
          O可选(Optional)
          Repeat 1

          To provide a description of real property

        • PDP
          Property Description - Personal
          O可选(Optional)
          Repeat 1

          To provide a description of personal property

        • III
          Information
          O可选(Optional)
          Repeat 10

          To report information

        • REF
          Reference Identification
          O可选(Optional)
          Repeat 1

          To specify identifying information

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat 9

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

  • SE
    Transaction Set Trailer
    M必须(Mandatory)
    Repeat 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)

Segment
X12 EDI Release 00403
STTransaction Set Header
To indicate the start of a transaction set and to assign a control number
Elements
  • ST01143Transaction Set Identifier Code
    ID
    M必须(Mandatory)
    Min 3 / Max 3

    Code uniquely identifying a Transaction Set

    Codes (320)
  • ST02329Transaction Set Control Number
    AN
    M必须(Mandatory)
    Min 4 / Max 9

    Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set

  • ST031705Implementation Convention Preference
    AN
    O可选(Optional)
    Min 1 / Max 9

    Reference assigned to identify Implementation Convention

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