[ X12 Examples ]
Com1 Software 270 Eligibility Inquiry Example
Posted: Friday, November 04 2022 5:15:47 PM
Com1 Software, Inc.
P.O. Box 482
Hudson, Ohio 44236
(330) 653-3771
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270 Eligibility Inquiry Example
270 Eligibility Inquiry source file.
ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *080319*2327*U*00501*002721171*0*P*:~ GS*HC*SENDER*RECEIVER*20080319*2327*27211711*X*005010X279A1~ ST*270*1234~ BHT*0022*13*10001234*19990501*1319~ HL*1**20*1~ NM1*PR*2*ABC COMPANY*****PI*842610001~ HL*2*1*21*1~ NM1*1P*2*CLINIC*****SV*2000035~ REF*N7*234899~ N3*11 HIGH STREET~ N4*SEATTLE*WA*98123~ PER*IC*BILLING DEPT*TE*2065551212*EX*2805*FX*2065551213~ PRV*PE*TJ*991231234*WA~ HL*3*2*22*1~ TRN*1*93175-012547*9877281234~ NM1*IL*1*SMITH*ROBERT*B***MI*11122333301~ REF*1L*599119~ N3*29 FREMONT ST*APT# 1~ N4*PEACE*NY*10023~ DMG*D8*19430519*M~ HL*4*3*23*0~ TRN*1*93175-012547*9877281234*RADIOLOGY~ NM1*03*1*SMITH*MARY LOU~ REF*SY*003221234~ N3*29 FREMONT ST*APT # 1~ N4*PEACE*NY*10023~ DMG*D8*19781014*F~ INS*N*19~ DTP*472*D8*19990501~ EQ*2~ SE*29*1234~ GE*1*27211711~ IEA*1*002721171~
Basic Inline
Base Mapping for the 270
********* 270 Eligibility Inquiry Configuration ************************************************** X12TRANSACTIONTYPE=270 KEYFIELD=HL,,,22 KEYLINEFIELD=EB FIELD=SUBID,16,NM1,IL,2,9 FIELD=SUBLNAME,32,NM1,IL,2,3,,SUBID FIELD=SUBFNAME,32,NM1,IL,2,4,,SUBID FIELD=SUBMI,1,NM1,IL,2,5,,SUBID FIELD=SUBADDR1,30,N3,,,1,,SUBID FIELD=SUBADDR2,30,N3,,,2,,SUBID FIELD=SUBCITY,30,N4,,,1,,SUBID FIELD=SUBST,2,N4,,,2,,SUBID FIELD=SUBZIP,10,N4,,,3,,SUBID FIELD=SUBSEX,1,DMG,,,3,,SUBID FIELD=SUBMSTATUS,1,DMG,,,4,,SUBID FIELD=SUBDOB,10,DMG,,,2,,SUBID FIELD=SUBREL,1,SBR,,,2,,SUBID FIELD=SUBORDER,1,SBR,0,1,,SUBID FIELD=SUBORDER,1,SBR,0,1,,SUBID FIELD=DEPID,16,NM1,QC,2,9,,SUBID FIELD=DEPFNAME,32,NM1,QC,2,3,,DEPID FIELD=DEPLNAME,32,NM1,QC,2,4,,DEPID FIELD=DEPMI,1,NM1,QC,2,5,,DEPID FIELD=DEPADDR1SUBADDR1,30,N3,,,1,,DEPID FIELD=DEPADDR2SUBADDR2,30,N3,,,2,,DEPID FIELD=DEPCITY,30,N4,,,1,,DEPID FIELD=DEPST,2,N4,,,2,,DEPID FIELD=DEPZIP,10,N4,,,2,,DEPID FIELD=DEPSEX,1,DMG,,,3,,DEPID FIELD=DEPMSTAT,1,DMG,,,4,,DEPID FIELD=DEPDOB,10,DMG,,,2,,DEPID FIELD=DEPREL,1,DEP,,,2,,DEPID FIELD=BENEFIT1,16,EB,,,1,2,CLAIMID,,,1 FIELD=COVERAGELEVEL1,16,EB,,,1,3,CLAIMID,,,1 FIELD=SERVICETYPE1,16,EB,,,1,3,CLAIMID,,,1 FIELD=DESCRIPTION1,16,EB,,,1,3,CLAIMID,,,1 FIELD=TIMEPERIOD1,16,EB,,,1,3,CLAIMID,,,1 FIELD=AMOUNT1,16,EB,,,1,3,CLAIMID,,,1 FIELD=BENEFIT2,16,EB,,,1,2,CLAIMID,,,2 FIELD=COVERAGELEVEL2,16,EB,,,1,3,CLAIMID,,,2 FIELD=SERVICETYPE2,16,EB,,,1,3,CLAIMID,,,2 FIELD=DESCRIPTION2,16,EB,,,1,3,CLAIMID,,,2 FIELD=TIMEPERIOD2,16,EB,,,1,3,CLAIMID,,,2 FIELD=AMOUNT2,16,EB,,,1,3,CLAIMID,,,2 FIELD=BENEFIT3,16,EB,,,1,2,CLAIMID,,,3 FIELD=COVERAGELEVEL3,16,EB,,,1,3,CLAIMID,,,3 FIELD=SERVICETYPE3,16,EB,,,1,3,CLAIMID,,,3 FIELD=DESCRIPTION3,16,EB,,,1,3,CLAIMID,,,3 FIELD=TIMEPERIOD3,16,EB,,,1,3,CLAIMID,,,3 FIELD=AMOUNT3,16,EB,,,1,3,CLAIMID,,,3 FIELD=BENEFIT4,16,EB,,,1,2,CLAIMID,,,4 FIELD=COVERAGELEVEL4,16,EB,,,1,3,CLAIMID,,,4 FIELD=SERVICETYPE4,16,EB,,,1,3,CLAIMID,,,4 FIELD=DESCRIPTION4,16,EB,,,1,3,CLAIMID,,,4 FIELD=TIMEPERIOD4,16,EB,,,1,3,CLAIMID,,,4 FIELD=AMOUNT4,16,EB,,,1,3,CLAIMID,,,4 FIELD=BENEFIT5,16,EB,,,1,2,CLAIMID,,,5 FIELD=COVERAGELEVEL5,16,EB,,,1,3,CLAIMID,,,5 FIELD=SERVICETYPE5,16,EB,,,1,3,CLAIMID,,,5 FIELD=DESCRIPTION5,16,EB,,,1,3,CLAIMID,,,5 FIELD=TIMEPERIOD5,16,EB,,,1,3,CLAIMID,,,5 FIELD=AMOUNT5,16,EB,,,1,3,CLAIMID,,,5 FIELD=BENEFIT6,16,EB,,,1,2,CLAIMID,,,6 FIELD=COVERAGELEVEL6,16,EB,,,1,3,CLAIMID,,,6 FIELD=SERVICETYPE6,16,EB,,,1,3,CLAIMID,,,6 FIELD=DESCRIPTION6,16,EB,,,1,3,CLAIMID,,,6 FIELD=TIMEPERIOD6,16,EB,,,1,3,CLAIMID,,,6 FIELD=AMOUNT6,16,EB,,,1,3,CLAIMID,,,6 FIELD=BENEFIT7,16,EB,,,1,2,CLAIMID,,,7 FIELD=COVERAGELEVEL7,16,EB,,,1,3,CLAIMID,,,7 FIELD=SERVICETYPE7,16,EB,,,1,3,CLAIMID,,,7 FIELD=DESCRIPTION7,16,EB,,,1,3,CLAIMID,,,7 FIELD=TIMEPERIOD7,16,EB,,,1,3,CLAIMID,,,7 FIELD=AMOUNT7,16,EB,,,1,3,CLAIMID,,,7 FIELD=BENEFIT8,16,EB,,,1,2,CLAIMID,,,8 FIELD=COVERAGELEVEL8,16,EB,,,1,3,CLAIMID,,,8 FIELD=SERVICETYPE8,16,EB,,,1,3,CLAIMID,,,8 FIELD=DESCRIPTION8,16,EB,,,1,3,CLAIMID,,,8 FIELD=TIMEPERIOD8,16,EB,,,1,3,CLAIMID,,,8 FIELD=AMOUNT8,16,EB,,,1,3,CLAIMID,,,8 FIELD=BENEFIT9,16,EB,,,1,2,CLAIMID,,,9 FIELD=COVERAGELEVEL9,16,EB,,,1,3,CLAIMID,,,9 FIELD=SERVICETYPE9,16,EB,,,1,3,CLAIMID,,,9 FIELD=DESCRIPTION9,16,EB,,,1,3,CLAIMID,,,9 FIELD=TIMEPERIOD9,16,EB,,,1,3,CLAIMID,,,9 FIELD=AMOUNT9,16,EB,,,1,3,CLAIMID,,,9 FIELD=BENEFIT10,16,EB,,,1,2,CLAIMID,,,10 FIELD=COVERAGELEVEL10,16,EB,,,1,3,CLAIMID,,,10 FIELD=SERVICETYPE10,16,EB,,,1,3,CLAIMID,,,10 FIELD=DESCRIPTION10,16,EB,,,1,3,CLAIMID,,,10 FIELD=TIMEPERIOD10,16,EB,,,1,3,CLAIMID,,,10 FIELD=AMOUNT10,16,EB,,,1,3,CLAIMID,,,10