Eligibility Tool

270/271 Eligibility Check Decoded

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Sample data. This uses Stedi's test environment with fictional member “Bernie Prohaska.” All names, addresses, member IDs, and benefit details shown here are synthetic — no real patient or plan information is represented.

What was sent

The 270 is an eligibility inquiry — a provider asking a payer "is this patient covered, and what are their benefits?" Here's what was submitted:

Eligibility inquiry (270)

→

Provider NPI

1447848577

Provider name

STEDI

Member ID

23051322

Trading partner

STEDI

Control number

000000175

Eligibility search ID

019a4bb8-3792-7b40-a5c6-2ce804c793cf

270 sent ⟶ Payer processes ⟶ 271 returned

How it works: The provider sends a 270 with the patient's member ID and their own NPI. The payer looks up the member, checks their coverage status, and returns a 271 with the full benefits breakdown. This all happens via the X12 EDI standard (specifically the 005010X279A1 implementation guide). What you see in the other tabs is the 271 that came back.

270 Request JSON

Stedi JSON format

{
  "provider": {
    "npi": "1447848577",
    "organizationName": "STEDI"
  },
  "subscriber": {
    "memberId": "23051322"
  },
  "eligibilitySearchId": "019a4bb8-3792-7b40-a5c6-2ce804c793cf",
  "submitterTransactionIdentifier": "175",
  "controlNumber": "000000175",
  "tradingPartnerServiceId": "STEDI",
  "stediTest": false
}

Subscriber

Bernie Prohaska

👤

Member ID

23051322

Date of birth

Jan 1, 1999

Gender

Male

Relationship

Employee (Self)

Address

Richmond Motorway, Prohaska borough, TN 84779

Plan details

Plan E20

🏥

Payer

Stedi Test

Group

Ferry LLC (#20126)

Plan number

527

Coverage level

Employee Only

Effective date

Jan 1, 2000

Expiration date

Dec 31, 2037

Cost sharing at a glance

Deductible (Individual)

$2,000

per calendar year

Deductible (Family)

$4,000

per calendar year

Coinsurance

30%

member responsibility

OOP max (Individual)

$7,500

per calendar year

OOP max (Family)

$15,000

per calendar year

Copay (Office visit)

$25

per visit

Copays

General office visit (Health Benefit Plan)

$25

Surgical / Oral Surgery / Infertility

$50

Copay applies to office visits.

Dental accident

$50

Copay applies to office visits.

Emergency (ER accident, ER medical, Emergency services)

$200

Copay is waived if member is admitted. Additional services subject to deductible & coinsurance.

Rx — Generic / Free standing / Mail order generic

$10

Rx — Mail order / Mail order brand name

$30

Deductibles

Individual — Health Benefit Plan

$2,000

Family — Health Benefit Plan

$4,000

Out-of-pocket maximums

Individual — All covered services

$7,500

Family — All covered services

$15,000

Individual — Durable Medical Equipment

$7,500

Family — Durable Medical Equipment

$15,000

Visit limits

Chiropractic

30 visits/yr

Skilled nursing care

100 visits/yr

Covered at 100% (preventive)

Medical care

100%

Consultation / Physician visits (sick & well)

100%

Maternity / OB-GYN / Gynecological

100%

Preventive services covered 100%.

Requires prior authorization

Surgical / Adjunctive dental / Oral surgery / Infertility

Auth req'd

Hospital (inpatient, outpatient, room & board, ambulatory surgical)

Auth req'd

Psychiatric (inpatient, outpatient, room & board)

Auth req'd

Dialysis / DME / Restorative

Auth req'd

Not covered — bill separately

Dental care / Routine preventive dental

Not covered

General dentistry is not covered and should be billed to the member's dental insurance carrier.

Vision (Optometry)

Not covered

General optometry should be billed to member's vision insurance carrier.

271 Response — raw X12

271 Response — Stedi JSON

270 Request — Stedi JSON

X12 segment legend (271)

ISA/IEAInterchange envelope (sender/receiver metadata) GS/GEFunctional group (transaction type: HB = eligibility) ST/SETransaction set (271 = eligibility/benefit response) BHTBeginning of hierarchical transaction HLHierarchical level (20=payer, 21=provider, 22=subscriber) NM1Name (PR=payer, 1P=provider, IL=subscriber) REFReference IDs (18=plan#, 6P=group#) N3/N4Address (street / city, state, zip) DMGDemographics (DOB, gender) INSInsurance relationship to subscriber DTPDate/time (346/347=plan dates, 539/540=policy dates) EBEligibility/benefit (1=active, A=coins, B=copay, C=deductible, D=description, F=limit, G=OOP max) MSGFree-form message (notes about coverage) TRNTrace number (for tracking the transaction)

ISA*00*          *00*          *ZZ*STEDI          *01*117151744      *251103*2157*^*00501*755429181*0*T*>~
GS*HB*STEDI*117151744*20251103*215743*1*X*005010X279A1~
ST*271*0001*005010X279A1~
BHT*0022*11*01K95VKQPRQF3KDHMB6B5K0FB3*20251103*215743~
HL*1**20*1~
NM1*PR*2*Stedi Test*****PI*STEDITEST~
HL*2*1*21*1~
NM1*1P*2*STEDI*****XX*1447848577~
HL*3*2*22*0~
TRN*1*01K95VKQPSFQP8J98TK3N967TN*3117151744~
NM1*IL*1*Prohaska*Bernie****MI*23051322~
REF*18*527*E20~
REF*6P*20126*Ferry LLC~
N3*Richmond Motorway*O'Connell Points~
N4*Prohaska borough*TN*84779~
DMG*D8*19990101*M~
INS*Y*18*001*25~
DTP*346*D8*20000101~
DTP*347*D8*20371231~
DTP*539*D8*20000101~
DTP*540*D8*20371231~
EB*1*EMP*30**E20~
EB*B**37**E20*23*50.0*****W~
MSG*Copay applies to office visits.~
EB*A**30**E20*23**.3****W~
EB*C*FAM*30**E20*23*4000.0*****W~
EB*C*IND*30**E20*23*2000.0*****W~
EB*B**30**E20*23*25.0*****W~
EB*F**33**E20*23***VS*30.0**W~
EB*D**35^41**E20*23******W~
MSG*General dentistry is not covered and should be billed to the members dental insurance carrier.~
EB*B**51^52^86**E20*23*200.0*****W~
MSG*Copay is waived if member is admitted.~
MSG*Additional services subject to deductible & coinsurance~
EB*B**89^92^BX**E20*23*10.0*****W~
EB*B**90^BW**E20*23*30.0*****W~
EB*F**AG**E20*23***VS*100.0**W~
EB*D**AL**E20*23******W~
MSG*General optometry should be billed to member's vision insurance carrier.~
EB*G*FAM*3^25^28^30^37^41^49^54^67^69^83^89^90^92^A4^A5^AJ^AK^BT^BU^BV^BW^BX^BY^BZ**E20*23*15000.0*****W~
EB*G*IND*3^25^28^30^37^41^49^54^67^69^83^89^90^92^A4^A5^AJ^AK^BT^BU^BV^BW^BX^BY^BZ**E20*23*7500.0*****W~
EB*G*FAM*DM**E20*23*15000.0*****W~
EB*G*IND*DM**E20*23*7500.0*****W~
EB*D**1**E20*23******W~
MSG*Preventive services covered 100%.~
EB*D**2^28^40^83**E20*23*****Y*W~
EB*B**2^28^40^83**E20*23*50.0*****W~
MSG*Copay applies to office visits.~
EB*D**3^BY^BZ**E20*23******W~
MSG*Preventive services covered 100%.~
EB*D**25^47^48^49^50^53^76^A5^A7^A8^DM**E20*23*****Y*W~
EB*D**69^98^BT^BU^BV**E20*23******W~
MSG*Preventive services covered 100%.~
SE*52*0001~
GE*1*1~
IEA*1*755429181~

{
  "provider": {
    "entityIdentifier": "Provider",
    "providerName": "STEDI",
    "entityType": "Non-Person Entity",
    "npi": "1447848577"
  },
  "eligibilitySearchId": "019a4bb8-3792-7b40-a5c6-2ce804c793cf",
  "planInformation": {
    "planDescription": "E20",
    "groupDescription": "Ferry LLC",
    "groupNumber": "20126",
    "planNumber": "527"
  },
  "planStatus": [
    {
      "serviceTypeCodes": ["30"],
      "planDetails": "E20",
      "status": "Active Coverage",
      "statusCode": "1"
    }
  ],
  "subscriber": {
    "lastName": "Prohaska",
    "dateOfBirth": "19990101",
    "groupNumber": "20126",
    "planDescription": "E20",
    "entityType": "Person",
    "firstName": "Bernie",
    "gender": "M",
    "groupDescription": "Ferry LLC",
    "address": {
      "address1": "Richmond Motorway",
      "city": "Prohaska borough",
      "state": "TN",
      "postalCode": "84779",
      "address2": "O'Connell Points"
    },
    "planNumber": "527",
    "entityIdentifier": "Insured or Subscriber",
    "memberId": "23051322"
  },
  "payer": {
    "entityType": "Non-Person Entity",
    "name": "Stedi Test",
    "payorIdentification": "STEDITEST",
    "entityIdentifier": "Payer"
  },
  "planDateInformation": {
    "policyExpiration": "20371231",
    "planBegin": "20000101",
    "policyEffective": "20000101",
    "planEnd": "20371231"
  },
  "benefitsInformation": ["... (22 benefit objects - see full response)"]
}

{
  "provider": {
    "npi": "1447848577",
    "organizationName": "STEDI"
  },
  "subscriber": {
    "memberId": "23051322"
  },
  "eligibilitySearchId": "019a4bb8-3792-7b40-a5c6-2ce804c793cf",
  "submitterTransactionIdentifier": "175",
  "controlNumber": "000000175",
  "tradingPartnerServiceId": "STEDI",
  "stediTest": false
}

270/271 Eligibility check