By | 2019-09-06T10:08:53+00:00 September 3rd, 2019|

What is an EDI 270-A1 Eligibility, Coverage or Benefit Inquiry?

An EDI 270-A1 document facilitates the exchange of information related to the eligibility, coverage, or benefits between the healthcare providers and insurance companies. The information exchanged includes data elements, such as the name and contact information of the sender of the inquiry, name of the recipient of the inquiry, and details of the insurance plan.

EDI X12 270-A1 Eligibility, Coverage or Benefit Inquiry Sample

An EDI 270 document is divided into functional groups that explain the contents of the transaction being conducted. A typical EDI 270-A1 document looks like this[1]:

ST*270*1234*005010×279~
BHT*0022*13*10001234*20101115*1319~
HL*1**20*1~
NM1*PR*2*BMCHP*****46*04337331~
HL*2*1*21*1~
NM1*1P*1*ITIS*ARTHUR*MD***XX*1234567890~
REF*N7*234899~
N3*39 DALTON STREET~
N4*BOSTON*MA*02199~
PER*IC*CHARLEY HORSE*TE*6175551212*EX*2805*FX*6175551213~
HL*3*2*22*1~
NM1*IL*1*TRIPPER*JACK*T***MI*111223303~
REF*1L*599119~
N3*29 JETPORT ROAD~
N4*CAMBRIDGE*MA*02138~
DMG*D8*19510519*M~
DTP*291*D8*20160630~
HL*4*3*23*0~
TRN*1*93175-012547*9877281234*RADIOLOGY~
NM1*03*1*TRIPPER*JACQUES~
REF*SY*003221234~
DMG*D8*20061014*F~
DTP*291*D8*20160630~
EQ*30**FAM~
SE*25*1234~

Workflow for the Exchange of an EDI 270-A1 Eligibility, Coverage or Benefit Inquiry

The EDI 270 and 271 transaction sets are one of the most commonly used transaction sets in the healthcare industry. Insurance companies use an EDI 271 Health Care Eligibility/Benefit Response document to convey information requested in an EDI 270-A1 transaction set.

Achieve EDI Compliance with Astera EDIConnect

Astera EDIConnect streamlines the exchange of EDI documents by allowing businesses to translate as well as construct EDI messages. With a built-in EDI parser, validator, and transaction builder, Astera EDIConnect can handle transaction sets in X12, EDIFACT, and HL7 formats.

[1] https://www.bmchp.org/-/media/18d1625949fb4efa9b9aee2b1f0d572d.ashx

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