EDI Resource Center

X12 EDI 270

What is an EDI 270 Eligibility, Coverage or Benefit Inquiry?

The EDI 270 Eligibility, Coverage, or Benefit Inquiry is a request for information from a healthcare provider to a health insurance provider about a policy's coverages, typically related to a specific plan subscriber. The 270 transaction is sent by healthcare service providers (hospitals or medical facilities) to insurance companies, government agencies or other organizations that would have information about a specific policy.

How is EDI 270 Used?

The 270 transaction is used for questions about the coverage of specific benefits for a given plan, such as diagnostic lab services, wheelchair rental, physical therapy services, etc. The transaction set is designed to be used by all lines of insurance including Health, Life, and Property and Casualty.

It is helpful for healthcare providers in determining whether a patient or service is covered by the patient's health insurance plan.

EDI 270 Benefits

The 270 transaction is used together with the EDI 271 transaction. The 271 is the healthcare Eligibility/Benefit Response and transfers the information requested in a 270. Combined, the EDI 270 and 271 transactions:

  • Allow for more detailed information exchanged electronically
  • Reduce manual data entry and related errors
  • Allow healthcare service providers (e.g. hospitals) to create HIPAA-compliant files requesting eligibility details for a patient.

Key Data Elements You'll Find in an Eligibility, Coverage or Benefit Inquiry:

  • Inquiry recipient name (the information source)
  • Inquiry sender details (name & contact information of the information receiver)
  • Benefit information or description of eligibility requested
  • Details of the plan subscriber to whom the inquiry is referring

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