An Eligibility, Coverage or Benefit Inquiry (270) is used by healthcare providers, employers, or other authorized entities to request real-time information about a patient’s or employee’s insurance coverage and benefits from a health plan or benefits administrator. Healthcare providers typically send the 270 to insurance companies or clearinghouses, which route it to the appropriate payer for processing. The transaction set uses the ST (Transaction Set Header) segment to initiate the inquiry, the BHT (Beginning of Hierarchical Transaction) segment to establish transaction control information, and the HL (Hierarchical Level) segment within Loop 2000 to organize the hierarchical structure of the inquiry, which may include information about the subscriber, dependent, or other parties involved in the coverage question.

For example, when a patient calls Dr. Jane’s Medical Practice to schedule a colonoscopy, the office staff submits a 270 inquiry through their practice management system to Blue Cross Blue Shield asking whether the patient is currently enrolled, what the deductible status is, and whether the procedure is a covered benefit. The inquiry includes the patient’s name via the NM1 (Individual or Organizational Name) segment in Loop 2100, and may include demographic details through the DMG (Demographic Information) segment and specific benefit questions through the EQ (Eligibility or Benefit Inquiry) segment in Loop 2110. Blue Cross Blue Shield receives the 270, processes it against their enrollment and benefits database, and typically responds within seconds with a 271 Eligibility, Coverage or Benefit Response, confirming coverage details and allowing Dr. Jane’s office to verify patient responsibility before the appointment.