270 Eligibility, Coverage or Benefit Inquiry (004010X092A1)
Providers send the 270 to ask a payer whether a patient is covered and which benefits apply. This is the standard X12 HIPAA 004010 spec, with 10 loops and 41 segment positions, as OpenEDI JSON, an ediFabric C# template and an ediFabric Native model. To change it for a trading partner, customize it in the EDI Spec Builder.
Use the 270 spec in your code
ediFabric .NET
Add the C# template and its common files to your project, or reference the template NuGet package, and read 270 files into TS270 objects. See ediFabric .NET.
ediFabric Native
Map version 004010X092A1 to the Native model with set_map, then parse 270 files to JSON from Python, Java, C or C#. See Convert between EDI and JSON.
OpenEDI
Select Customize in Spec Builder to copy the spec under your own name, change it for your partner, and parse files against it in EdiNation, ediFabric Native or ediFabric Cloud. Read about OpenEDI.
Generate 270 classes in Python, Java, Node.js, Go, Rust or C
ediFabric Native returns each 270 as JSON, with the property names of the OpenEDI schema. To work with that JSON as typed objects, generate classes from the OpenEDI file in your language and deserialize the JSON into TS270. Serialize the objects back to JSON to build EDI with ediFabric Native. The classes keep the loops, segments, lengths and code lists, but not the EDI data formats, so validate files with ediFabric Native. Read more in Generate a class from OpenEDI.
Python: datamodel-code-generator. Node.js: openapi-typescript. Java, Go, Rust and C: OpenAPI Generator.
For a sample file, the same data as JSON, and code to parse, validate and generate the 270, see the 270 transaction guide.
270 structure
Loops and segments of the standard 270, with their usage and maximum repeats.
| ID | Name | Usage | Max use |
|---|---|---|---|
| ST | Transaction Set Header | Optional | 1 |
| BHT | Beginning Of Hierarchical Transaction | Mandatory | 1 |
| Loop HL | Information Source Level | Mandatory | >1 |
| HL | Information Source Level | Mandatory | 1 |
| Loop NM1 | Information Source Name | Mandatory | 1 |
| NM1 | Information Source Name | Mandatory | 1 |
| Loop HL | Information Receiver Level | Mandatory | >1 |
| HL | Information Receiver Level | Mandatory | 1 |
| Loop NM1 | Information Receiver Name | Mandatory | 1 |
| NM1 | Information Receiver Name | Mandatory | 1 |
| REF | Information Receiver Additional Identification | Optional | 9 |
| N3 | Information Receiver Address | Optional | 1 |
| N4 | Information Receiver City State ZIP Code | Optional | 1 |
| PER | Information Receiver Contact Information | Optional | 3 |
| PRV | Information Receiver Provider Information | Optional | 1 |
| Loop HL | Subscriber Level | Mandatory | >1 |
| HL | Subscriber Level | Mandatory | 1 |
| TRN | Subscriber Trace Number | Optional | 2 |
| Loop NM1 | Subscriber Name | Mandatory | 1 |
| NM1 | Subscriber Name | Mandatory | 1 |
| REF | Subscriber Additional Identification | Optional | 9 |
| N3 | Subscriber Address | Optional | 1 |
| N4 | Subscriber City State ZIP Code | Optional | 1 |
| PRV | Provider Information | Optional | 1 |
| DMG | Subscriber Demographic Information | Optional | 1 |
| INS | Subscriber Relationship | Optional | 1 |
| DTP | Subscriber Date | Optional | 2 |
| Loop EQ | Subscriber Eligibility Or Benefit Inquiry Information | Optional | 99 |
| EQ | Subscriber Eligibility Or Benefit Inquiry Information | Optional | 1 |
| AMT | Subscriber Spend Down Amount | Optional | 1 |
| III | Subscriber Eligibility Or Benefit Additional Inquiry Information | Optional | 10 |
| REF | Subscriber Additional Information | Optional | 1 |
| DTP | Subscriber Eligibility Benefit Date | Optional | 1 |
| Loop HL | Dependent Level | Optional | >1 |
| HL | Dependent Level | Mandatory | 1 |
| TRN | Dependent Trace Number | Optional | 2 |
| Loop NM1 | Dependent Name | Mandatory | 1 |
| NM1 | Dependent Name | Mandatory | 1 |
| REF | Dependent Additional Identification | Optional | 9 |
| N3 | Dependent Address | Optional | 1 |
| N4 | Dependent City State ZIP Code | Optional | 1 |
| PRV | Provider Information | Optional | 1 |
| DMG | Dependent Demographic Information | Optional | 1 |
| INS | Dependent Relationship | Optional | 1 |
| DTP | Dependent Date | Optional | 2 |
| Loop EQ | Dependent Eligibility Or Benefit Inquiry Information | Optional | 99 |
| EQ | Dependent Eligibility Or Benefit Inquiry Information | Optional | 1 |
| III | Dependent Eligibility Or Benefit Additional Inquiry Information | Optional | 10 |
| REF | Dependent Additional Information | Optional | 1 |
| DTP | Dependent Eligibility Benefit Date | Optional | 1 |
| SE | Transaction Set Trailer | Optional | 1 |