X12 270 eligibility inquiry: format and example

270 structure

The full X12 270 layout from its OpenEDI definition, the same model ediFabric uses to parse, validate and generate it: 10 loops and 43 segment positions, in file order. Loops are shaded and their segments indented; Max use is how many times a segment or loop may repeat.

Segment / loop	Name	Usage	Max use
`ST`	Transaction Set Header	Required	1
`BHT`	Beginning of Hierarchical Transaction	Required	1
Loop 2000A	Information Source Level	Required	>1
`HL`	Information Source Level	Required	1
Loop 2100A	Information Source Name	Required	1
`NM1`	Information Source Name	Required	1
Loop 2000B	Information Receiver Level	Required	>1
`HL`	Information Receiver Level	Required	1
Loop 2100B	Information Receiver Name	Required	1
`NM1`	Information Receiver Name	Required	1
`REF`	Information Receiver Additional Identification	Situational	9
`N3`	Information Receiver Address	Situational	1
`N4`	Information Receiver City State ZIP Code	Situational	1
`PRV`	Information Receiver Provider Information	Situational	1
Loop 2000C	Subscriber Level	Required	>1
`HL`	Subscriber Level	Required	1
`TRN`	Subscriber Trace Number	Situational	2
Loop 2100C	Subscriber Name	Required	1
`NM1`	Subscriber Name	Required	1
`REF`	Subscriber Additional Identification	Situational	9
`N3`	Subscriber Address	Situational	1
`N4`	Subscriber City State ZIP Code	Situational	1
`PRV`	Provider Information	Situational	1
`DMG`	Subscriber Demographic Information	Situational	1
`INS`	Multiple Birth Sequence Number	Situational	1
`HI`	Subscriber Health Care Diagnosis Code	Situational	1
`DTP`	Subscriber Date	Situational	2
Loop 2110C	Subscriber Eligibilityor Benefit Inquiry	Situational	99
`EQ`	Subscriber Eligibilityor Benefit Inquiry	Required	1
Any order	The loops below can appear in any order	Situational	1
`AMT`	Subscriber Spend Down Amount	Situational	1
`AMT`	Subscriber Spend Down Total Billed Amount	Situational	1
`III`	Subscriber Eligibilityor Benefit Additional Inquiry Information	Situational	1
`REF`	Subscriber Additional Information	Situational	1
`DTP`	Subscriber Eligibility Benefit Date	Situational	1
Loop 2000D	Dependent Level	Situational	>1
`HL`	Dependent Level	Required	1
`TRN`	Dependent Trace Number	Situational	2
Loop 2100D	Dependent Name	Required	1
`NM1`	Dependent Name	Required	1
`REF`	Dependent Additional Identification	Situational	9
`N3`	Dependent Address	Situational	1
`N4`	Dependent City State ZIP Code	Situational	1
`PRV`	Provider Information	Situational	1
`DMG`	Dependent Demographic Information	Situational	1
`INS`	Dependent Relationship	Situational	1
`HI`	Dependent Health Care Diagnosis Code	Situational	1
`DTP`	Dependent Date	Situational	2
Loop 2110D	Dependent Eligibilityor Benefit Inquiry	Required	99
`EQ`	Dependent Eligibilityor Benefit Inquiry	Required	1
`III`	Dependent Eligibilityor Benefit Additional Inquiry Information	Situational	1
`REF`	Dependent Additional Information	Situational	1
`DTP`	Dependent Eligibility Benefit Date	Situational	1
`SE`	Transaction Set Trailer	Required	1

Usage follows the 005010X279A1 implementation guide: Required segments must be sent, Situational ones only when the guide's condition applies. Trading partners often add their own rules in companion guides - ediFabric templates can be adjusted to match. Open the element-level definition in the EdiNation spec library.

Sample 270 file

An eligibility inquiry for one subscriber. Paste it into EdiNation to see every element named and validated.

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~

The same 270 as JSON

ediFabric turns every loop, segment and element into a named field. This is the transaction from the sample, in the JSON that ediFabric Native and Cloud return and accept.

{
  "ST": {
    "TransactionSetIdentifierCode_01": "270",
    "TransactionSetControlNumber_02": "1234",
    "ImplementationConventionPreference_03": "005010X279A1"
  },
  "BHT_BeginningOfHierarchicalTransaction": {
    "HierarchicalStructureCode_01": "0022",
    "TransactionSetPurposeCode_02": "13",
    "SubmitterTransactionIdentifier_03": "10001234",
    "TransactionSetCreationDate_04": "20060501",
    "TransactionSetCreationTime_05": "1319"
  },
  "Loop2000A": [
    {
      "HL_InformationSourceLevel": {
        "HierarchicalIDNumber_01": "1",
        "HierarchicalLevelCode_03": "20",
        "HierarchicalChildCode_04": "1"
      },
      "Loop2100A": {
        "NM1_InformationSourceName": {
          "EntityIdentifierCode_01": "PR",
          "EntityTypeQualifier_02": "2",
          "ResponseContactLastorOrganizationName_03": "ABC COMPANY",
          "IdentificationCodeQualifier_08": "PI",
          "ResponseContactIdentifier_09": "842610001"
        }
      },
      "Loop2000B": [
        {
          "HL_InformationReceiverLevel": {
            "HierarchicalIDNumber_01": "2",
            "HierarchicalParentIDNumber_02": "1",
            "HierarchicalLevelCode_03": "21",
            "HierarchicalChildCode_04": "1"
          },
          "Loop2100B": {
            "NM1_InformationReceiverName": {
              "EntityIdentifierCode_01": "1P",
              "EntityTypeQualifier_02": "2",
              "ResponseContactLastorOrganizationName_03": "BONE AND JOINT CLINIC",
              "IdentificationCodeQualifier_08": "SV",
              "ResponseContactIdentifier_09": "2000035"
            }
          },
          "Loop2000C": [
            {
              "HL_SubscriberLevel": {
                "HierarchicalIDNumber_01": "3",
                "HierarchicalParentIDNumber_02": "2",
                "HierarchicalLevelCode_03": "22",
                "HierarchicalChildCode_04": "0"
              },
              "TRN_SubscriberTraceNumber": [
                {
                  "TraceTypeCode_01": "1",
                  "CurrentTransactionTraceNumber_02": "93175-012547",
                  "OriginatingCompanyIdentifier_03": "9877281234"
                }
              ],
              "Loop2100C": {
                "NM1_SubscriberName": {
                  "EntityIdentifierCode_01": "IL",
                  "EntityTypeQualifier_02": "1",
                  "ResponseContactLastorOrganizationName_03": "SMITH",
                  "ResponseContactFirstName_04": "ROBERT",
                  "IdentificationCodeQualifier_08": "MI",
                  "ResponseContactIdentifier_09": "11122333301"
                },
                "DMG_SubscriberDemographicInformation": {
                  "DateTimePeriodFormatQualifier_01": "D8",
                  "DependentBirthDate_02": "19430519"
                },
                "DTP_SubscriberDate": [
                  {
                    "DateTimeQualifier_01": "291",
                    "DateTimePeriodFormatQualifier_02": "D8",
                    "DateTimePeriod_03": "20060501"
                  }
                ],
                "Loop2110C": [
                  {
                    "EQ_SubscriberEligibilityorBenefitInquiry": {
                      "ServiceTypeCode_01": [
                        "30"
                      ]
                    }
                  }
                ]
              }
            }
          ]
        }
      ]
    }
  ],
  "SE": {
    "NumberofIncludedSegments_01": "13",
    "TransactionSetControlNumber_02": "1234"
  }
}

Parse and validate a 270 file

Read the file into typed objects with ediFabric .NET, convert it to JSON in process with the ediFabric Native bindings for Python, Java and C, or post it to the ediFabric Cloud REST API from any language.

.NET
Python
Java
C
Cloud

using EdiFabric.Templates.Hipaa5010;

License.SetSerial("YOUR_SERIAL_KEY");

using (var stream = File.OpenRead(@"C:\edi\GenericRequest.txt"))
using (var reader = new X12Reader(stream, "EdiFabric.Templates.Hipaa"))
{
    var items = await reader.ReadToEndAsync();
    foreach (var transaction in items.OfType<TS270>())
    {
        if (transaction.IsValid(out MessageErrorContext errors))
            Console.WriteLine($"{transaction.ST.TransactionSetControlNumber_02} is valid");
        else
            Console.WriteLine(string.Join(Environment.NewLine, errors.Flatten()));
    }
} Install and get started 270 example project Walkthrough
import json
import edifabric_x12 as ef

serial = "YOUR_SERIAL_KEY"
ef.load_library()
ef.set_serial(serial)
ef.set_map(json.dumps({"default": serial, "maps": {}}))

edi = open("GenericRequest.txt", "rb").read()
output, offset = ef.parse(edi, ef.ParseMode.JSON_VALIDATE)
transactions = output[:offset]
report = json.loads(output[offset:])
print(report["errors_count"]) Python bindingsediFabric Native
import com.edifabric.nativex12.EdiFabricX12;
import com.edifabric.nativex12.ParseMode;
import com.edifabric.nativex12.ParseResult;

String serial = "YOUR_SERIAL_KEY";
EdiFabricX12.loadLibrary();
EdiFabricX12.setSerial(serial);
EdiFabricX12.setMap("{\"default\":\"" + serial + "\",\"maps\":{}}");

String edi = Files.readString(Path.of("GenericRequest.txt"));
ParseResult result = EdiFabricX12.parse(edi, ParseMode.JSON_VALIDATE);
System.out.println(result.getTransactions());
System.out.println(result.getReport()); Java bindingsediFabric Native
#include "edifabric_x12.h"

const char *serial = "YOUR_SERIAL_KEY";
ef_parse_result result;

if (ef_load_library(NULL) != 0)
    return 1;
ef_set_serial(serial);
ef_set_map("{\"default\":\"YOUR_SERIAL_KEY\",\"maps\":{}}");

char *edi = read_file("GenericRequest.txt", NULL);   /* helper in example_all_functions.c */
if (ef_parse(edi, EF_PARSE_JSON_VALIDATE, NULL, &result) == 0) {
    /* transactions = output[0 .. offset), report = output[offset .. length) */
    fwrite(result.output.data, 1, (size_t)result.output.length, stdout);
    ef_free(result.output.data);
} C bindingsediFabric Native
curl -X POST 'https://api.edination.com/v2/x12/read' \
-H 'Ocp-Apim-Subscription-Key: YOUR_SERIAL_KEY' \
-H 'Content-Type: application/octet-stream' \
--data-binary '@GenericRequest.txt' TranslateValidateediFabric Cloud

Generate a 270 file

Populate a TS270 object in .NET, or pass JSON in the shape shown above to ediFabric Native or ediFabric Cloud, and get a valid 270 file back.

.NET
Python
Java
C
Cloud

using EdiFabric.Templates.Hipaa5010;

License.SetSerial("YOUR_SERIAL_KEY");

var transaction = new TS270();

//  Transaction Set ID Code = 270 (Eligibility, Coverage or Benefit Inquiry)
//  Transaction Set Control Number = 1234
//  Implementation Convention Reference = 005010X279A1
transaction.ST = new ST();
transaction.ST.TransactionSetIdentifierCode_01 = "270";
transaction.ST.TransactionSetControlNumber_02 = "0001";
transaction.ST.ImplementationConventionPreference_03 = "005010X279A1";

//  Hierarchical Structure Code = 0022 (Information Source, Information Receiver, Subscriber, Dependent)
//  Transaction Set Purpose Code = 13(Request) Identification
//  Reference Identification = 10001234
//  Date = 20060501(May 1, 2006)
//  Time = 1:19 PM
transaction.BHT_BeginningOfHierarchicalTransaction = new BHT_BeginningOfHierarchicalTransaction();
transaction.BHT_BeginningOfHierarchicalTransaction.HierarchicalStructureCode_01 = "0022";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetPurposeCode_02 = "13";
transaction.BHT_BeginningOfHierarchicalTransaction.SubmitterTransactionIdentifier_03 = "10001234";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationDate_04 = "20060501";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationTime_05 = "1319";

// ... set the remaining loops and segments the same way

// SegmentBuilders is in the Common project of the example repository
using (var stream = new MemoryStream())
{
    using (var writer = new X12Writer(stream))
    {
        writer.Write(SegmentBuilders.BuildIsa("1"));
        writer.Write(SegmentBuilders.BuildGs("1", "SENDER1", "RECEIVER1", "005010X279A1"));
        writer.Write(transaction);
    }
    Console.WriteLine(Encoding.UTF8.GetString(stream.ToArray()));
} Install and get started Full 270 build methodExample repository
import json
import edifabric_x12 as ef

serial = "YOUR_SERIAL_KEY"
ef.load_library()
ef.set_serial(serial)
ef.set_map(json.dumps({"default": serial, "maps": {}}))

# the transactions JSON returned by ef.parse, edited or produced by your application
transactions = open("GenericRequest.json", "rb").read()
edi = ef.build(transactions, postfix="\r\n")
print(edi) Python bindings
import com.edifabric.nativex12.EdiFabricX12;

String serial = "YOUR_SERIAL_KEY";
EdiFabricX12.loadLibrary();
EdiFabricX12.setSerial(serial);
EdiFabricX12.setMap("{\"default\":\"" + serial + "\",\"maps\":{}}");

// the transactions JSON returned by parse, edited or produced by your application
String transactions = Files.readString(Path.of("GenericRequest.json"));
String edi = EdiFabricX12.build(transactions, "\r\n");
System.out.println(edi); Java bindings
#include "edifabric_x12.h"

ef_buffer edi;

if (ef_load_library(NULL) != 0)
    return 1;
ef_set_serial("YOUR_SERIAL_KEY");
ef_set_map("{\"default\":\"YOUR_SERIAL_KEY\",\"maps\":{}}");

/* the transactions JSON returned by ef_parse, edited or produced by your application */
char *transactions = read_file("GenericRequest.json", NULL);
if (ef_build(transactions, "\r\n", &edi) == 0) {
    fwrite(edi.data, 1, (size_t)edi.length, stdout);
    ef_free(edi.data);
} C bindings
# the JSON returned by /read, edited or produced by your application
curl -X POST 'https://api.edination.com/v2/x12/write' \
-H 'Ocp-Apim-Subscription-Key: YOUR_SERIAL_KEY' \
-H 'Content-Type: application/json' \
--data-binary '@GenericRequest.json' \
-o 'GenericRequest.txt' How-tosediFabric Cloud

270 questions

What is the minimum data for a 270?

The payer, the provider with NPI, and enough to identify the member - usually the member ID with name and date of birth - plus at least one EQ service type code.

What does service type code 30 mean?

Health benefit plan coverage. It asks for the general benefits and returns the most common service types. Specific codes such as 88 pharmacy or 98 professional visit ask for those benefits only.

What is the response to a 270?

A 271 with the eligibility and benefit details, or AAA segments explaining why the request was rejected.

How do I parse and generate X12 270 files in .NET, Python, Java and C?

In .NET, install EdiFabric and EdiFabric.Templates.Hipaa, read the file with X12Reader into TS270 objects and write them back with X12Writer. From Python, Java or C, use ediFabric Native, which converts 270 files to JSON and JSON back to X12 inside your process. From any other language, post the file to the ediFabric Cloud REST API.

Related transactions

X12 271 - Eligibility, Coverage or Benefit Information
X12 278 - Health Care Services Review: Request for Review and Response
X12 276 - Health Care Claim Status Request
All EDI transactions →

X12 270 Eligibility, Coverage or Benefit Inquiry

At a glance