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.
To indicate the start of a transaction set and to assign a control number
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
To identify dependencies among and the content of hierarchically related groups of data segments
To uniquely identify a transaction to an application
To supply the full name of an individual or organizational entity
To specify identifying information
To specify additional names or those longer than 35 characters in length
To specify the location of the named party
To specify the geographic place of the named party
To identify a person or office to whom administrative communications should be directed
To specify the identifying characteristics of a provider
To supply demographic information
To provide benefit information on insured entities
To specify any or all of a date, a time, or a time period
To specify inquired eligibility or benefit information
To indicate the total monetary amount
To provide descriptions that identify a specific vehicle
To provide a description of real property
To provide a description of personal property
To report information
To specify identifying information
To specify any or all of a date, a time, or a time period
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)
