EDI 270

Healthcare Eligibility/Benefit Inquiry

The EDI 270 transaction is a Healthcare Eligibility/Benefit Inquiry used by healthcare providers in conjunction with the EDI 271 transaction which is sent in response with the plan details.
 

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What is an EDI 270?

The EDI 270 Health Care Eligibility/Benefit Inquiry is a type of EDI transaction set used by healthcare providers to request insurance coverage details for a specific patient. This electronic transaction replaces traditional phone inquiries, providing more detailed information about policy benefits.

 

 

How to use an EDI 270?

Healthcare providers use the EDI 270 Health Care Eligibility/Benefit Inquiry to electronically check a patient’s insurance coverage before providing services. They gather patient and policy details, send a 270 request through EDI software, and receive an EDI 271 response from the insurer, detailing coverage, copays, and deductibles. This process speeds up verification, reduces administrative workload, improves billing accuracy, and ensures HIPAA compliance.

What Information Does the EDI 270 Include?

An EDI 270 transaction typically contains:

  • Sender details (name and contact information)
  • Recipient details (insurance provider or information source)
  • Plan subscriber details (patient or dependent information)
  • Eligibility/benefit request details (specific coverage or service inquiries)
     

HIPAA Compliance and EDI 270/271

As of March 31, 2012, healthcare providers must comply with HIPAA version 5010 for EDI transactions. EDI/HQ™ Healthcare software ensures full HIPAA-compliant EDI processing, offering:

  • Advanced EDI translation
  • Superior mapping and integration
  • Enhanced data management

Other Common X12 Transactions Related to EDI 270

View the most commonly used EDI transactions.

More EDI Transactions
EDI 270 transaction healthcare provider

Cleo can assist with EDI 270s (and so much more)

Choose the EDI Integration package that best fits your business:

 

  • Create and deploy your own integrations using Cleo's intuitive, self-service design platform.
  • Utilize Cleo's EDI-managed services team to design and build your integrations.
  • Blend our EDI expertise and your business knowledge together in any manner that suits your use case.

New to EDI? Learn more

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