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Spotlight PEPPOL BIS Billing 3.0 The EU e-invoicing mandate is here — France Sept 2026, Belgium Jan 2026, Germany 2025.

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X12 270 — Eligibility, Coverage or Benefit Inquiry

Eligibility inquiry sent by a provider to a payer (health insurer) to verify a patient's coverage prior to a service or procedure.

Purpose

The 270 asks a payer about a member's coverage: is the plan active? which services are covered? what is the patient responsibility (deductible, copay, coinsurance, out-of-pocket maximum)? It is typically emitted in real time at appointment scheduling or admission, sometimes batched (overnight) for the day's patient list. The payer answers with a 271.

Envelope and structure

The 270 uses the triple X12 envelope with a GS of type HS (Health Care Eligibility / Benefit Information). The ST segment carries the implementation-guide identifier (005010X279A1) as its third element — this is mandatory under HIPAA. A minimal example checking a patient's eligibility:

x12 minimal-270.x12 
ISA*00*          *00*          *ZZ*PROVIDER01     *ZZ*PAYER99        *260513*0815*U*00501*000000270*0*P*>~
GS*HS*PROVIDER01*PAYER99*20260513*0815*1*X*005010X279A1~
ST*270*0001*005010X279A1~
BHT*0022*13*REQ-0001*20260513*0815~
HL*1**20*1~
NM1*PR*2*PAYER99*****PI*PAYER99~
HL*2*1*21*1~
NM1*1P*2*ACME CLINIC*****XX*1234567890~
HL*3*2*22*0~
TRN*1*TRACE-0001*9PROVIDER01~
NM1*IL*1*DOE*JANE****MI*MEMBER12345~
DMG*D8*19850412*F~
DTP*291*D8*20260513~
EQ*30~
SE*13*0001~
GE*1*1~
IEA*1*000000270~

Common segments (concept)

  • Header — BHT Beginning of Hierarchical Transaction identifies the request (reference, date), followed by four hierarchical HL loop levels: 2000A Information Source (the payer), 2000B Information Receiver (the provider asking), 2000C Subscriber (the member who holds the contract), and 2000D Dependent (a possible dependent, child or spouse).
  • Detail (per level) — NM1 Individual or Organizational Name identifies each party, DMG Demographic Information carries the patient's date of birth and gender, DTP Date or Time or Period defines the requested eligibility date, and EQ Eligibility or Benefit Inquiry targets the requested information via a service type code (30 = Health Benefit Plan Coverage, 35 = Dental, 88 = Pharmacy…).
  • Summary — a single SE.

When you'll see it

The 270 is the workhorse of the US healthcare front office: it is exchanged hundreds of millions of times per day between clinics, hospitals, pharmacies and payers via clearinghouses Availity, Change Healthcare (Optum), Waystar, Trizetto. Every practice, ED, imaging lab or pharmacy that checks a patient's eligibility actually sends a 270 under the hood — whether driven from Epic, Cerner, Athenahealth, NextGen or a web portal.

Documentation