270 CSV Schema

This document defines the CSV format for generating 270 (Health Care Eligibility/Benefit Inquiry) files. Upload a CSV with member information to generate properly formatted EDI 270 transactions.

Quick Start

Download a sample template
Fill in your data (one row per member/service type combination)
Upload to EDI Paisan's 270 Generator
Download your generated 270 file

CSV Structure

Each row represents one eligibility inquiry — a combination of member + service type. To check multiple service types for the same member, use multiple rows.

Row Types

Scenario	Rows Needed
1 subscriber, 1 service type	1 row
1 subscriber, 3 service types	3 rows
1 subscriber + 2 dependents, 1 service each	3 rows
1 subscriber + 1 dependent, 2 services each	4 rows

Required Fields

These fields must have values in every row:

Column	Description	Example
`PayerID`	Payer's identifier (from payer list)	`BCBS01`
`PayerName`	Payer organization name	`Blue Cross Blue Shield`
`MemberID`	Subscriber's member/policy ID	`MEM123456789`
`MemberLastName`	Member's last name	`Smith`
`MemberFirstName`	Member's first name	`John`
`MemberDOB`	Member's date of birth (MM/DD/YYYY)	`03/15/1985`
`ServiceTypeCode`	Service type to check (see codes)	`30`

Why These Are Required

PayerID/PayerName: Identifies who to send the inquiry to
MemberID: Primary lookup key for the payer
Member Name/DOB: Verification against payer records
ServiceTypeCode: Specifies what coverage to check

Optional Fields

Member Information

Column	Description	Example	Notes
`MemberMiddleName`	Middle name or initial	`Robert`
`MemberSuffix`	Name suffix	`Jr`	JR, SR, III, etc.
`MemberGender`	Gender code	`M`	M=Male, F=Female, U=Unknown
`MemberAddress`	Street address	`123 Main St`
`MemberCity`	City	`Chicago`
`MemberState`	State code	`IL`	2-letter state code
`MemberZip`	ZIP code	`60601`	5 or 9 digits
`MemberRelationship`	Relationship to subscriber	`18`	See relationship codes

Subscriber Information (when different from member)

Use these when the inquiry is for a dependent (child, spouse) and you need to include subscriber info:

Column	Description	Example
`SubscriberID`	Subscriber's member ID	`MEM123456789`
`SubscriberLastName`	Subscriber's last name	`Smith`
`SubscriberFirstName`	Subscriber's first name	`John`
`SubscriberMiddleName`	Subscriber's middle name	`Robert`
`SubscriberDOB`	Subscriber's DOB	`03/15/1985`
`SubscriberGender`	Subscriber's gender	`M`

When to use: If MemberRelationship is anything other than 18 (Self), include subscriber fields.

Service Inquiry Details

Column	Description	Example	Notes
`CoverageLevel`	Individual or family	`IND`	IND=Individual, FAM=Family
`IndustryCode`	Medical/Dental/Vision		Leave blank for medical
`ServiceDateFrom`	Service date or range start	`01/15/2024`	MM/DD/YYYY
`ServiceDateTo`	Service date range end	`01/31/2024`	MM/DD/YYYY

Provider Information

Column	Description	Example	Notes
`ProviderNPI`	Requesting provider's NPI	`1234567890`	10 digits
`ProviderName`	Provider organization name	`ABC Medical Group`
`ProviderTaxID`	Provider's tax ID	`123456789`	9 digits (EIN)

Tracking

Column	Description	Example	Notes
`TraceNumber`	Your reference number	`TRACE001`	Returned in 271 for matching
`GroupNumber`	Employer group number	`GRP123`	If known
`PolicyNumber`	Policy/contract number	`POL456`	If different from MemberID

Service Type Codes

The ServiceTypeCode field specifies what coverage to check:

Common Codes

Code	Description	Use Case
`30`	Health Benefit Plan Coverage	General eligibility check — start here
`1`	Medical Care	General medical services
`2`	Surgical	Surgery coverage
`3`	Consultation	Specialist visits
`4`	Diagnostic X-Ray	Imaging coverage
`5`	Diagnostic Lab	Lab work coverage
`33`	Chiropractic	Chiropractic services
`35`	Dental Care	Dental coverage
`47`	Hospital	Hospital services (general)
`48`	Hospital - Inpatient	Inpatient admission
`50`	Hospital - Outpatient	Outpatient services
`51`	Hospital - ER (Accident)	Emergency - accident
`52`	Hospital - ER (Medical)	Emergency - medical
`86`	Emergency Services	ER coverage
`88`	Pharmacy	Prescription drug coverage
`98`	Professional (Physician) Visit	Office visits
`UC`	Urgent Care	Urgent care coverage

Additional Codes

Code	Description
`6`	Radiation Therapy
`7`	Anesthesia
`8`	Surgical Assistance
`12`	Durable Medical Equipment
`14`	Renal Supplies in the Home
`23`	Diagnostic Dental
`24`	Periodontics
`25`	Restorative
`26`	Endodontics
`27`	Maxillofacial Prosthetics
`28`	Adjunctive Dental Services
`34`	Dental Crowns
`36`	Dental Accident
`37`	Orthodontics
`38`	Prosthodontics
`39`	Oral Surgery
`40`	Preventive Dental
`42`	Home Health Care
`43`	Home Health Prescriptions
`44`	Home Health Visits
`45`	Hospice
`46`	Respite Care
`49`	Hospital - Room and Board
`53`	Hospital - Ambulatory Surgical
`54`	Long Term Care
`55`	Major Medical
`56`	Medically Related Transportation
`57`	Air Transportation
`58`	Cabulance
`59`	Licensed Ambulance
`60`	General Benefits
`61`	In-vitro Fertilization
`62`	MRI/CAT Scan
`63`	Donor Procedures
`64`	Acupuncture
`65`	Newborn Care
`66`	Pathology
`67`	Smoking Cessation
`68`	Well Baby Care
`69`	Maternity
`70`	Transplants
`71`	Audiology Exam
`72`	Inhalation Therapy
`73`	Diagnostic Medical
`74`	Private Duty Nursing
`75`	Prosthetic Device
`76`	Dialysis
`77`	Otological Exam
`78`	Chemotherapy
`79`	Allergy Testing
`80`	Immunizations
`81`	Routine Physical
`82`	Family Planning
`83`	Infertility
`84`	Abortion
`85`	AIDS
`87`	Podiatry
`89`	Free Standing Prescription Drug
`90`	Mail Order Prescription Drug
`91`	Brand Name Prescription Drug
`92`	Generic Prescription Drug
`93`	Podiatry - Nursing Home Visits
`94`	Podiatry - Office Visits
`95`	Podiatry - Surgery
`96`	Psychotherapy
`97`	Social Work
`99`	Other Medical
`A0`	Combined Medical and Dental
`A1`	Physicians Visit - Office
`A2`	Physicians Visit - Home
`A3`	Physicians Visit - Inpatient
`A4`	Psychiatric
`A5`	Psychiatric - Room and Board
`A6`	Psychotherapy - Inpatient
`A7`	Psychotherapy - Outpatient
`A8`	Psychiatric - Outpatient
`A9`	Rehabilitation
`AA`	Rehabilitation - Inpatient
`AB`	Rehabilitation - Outpatient
`AC`	Occupational Therapy
`AD`	Physical Medicine
`AE`	Speech Therapy
`AF`	Skilled Nursing Care
`AG`	Skilled Nursing Care - Room and Board
`AH`	Substance Abuse
`AI`	Alcoholism
`AJ`	Drug Addiction
`AK`	Vision
`AL`	Frames
`AM`	Routine Eye Exam
`AN`	Lenses
`AO`	Routine Exam
`AQ`	Non-Medically Necessary Physical
`AR`	Experimental Drug Therapy
`BA`	Independent Medical Evaluation
`BB`	Partial Hospitalization (Psychiatric)
`BC`	Day Care (Psychiatric)
`BD`	Cognitive Therapy
`BE`	Massage Therapy
`BF`	Pulmonary Rehabilitation
`BG`	Cardiac Rehabilitation
`BH`	Pediatric
`BI`	Nursery
`BJ`	Skin
`BK`	Orthopedic
`BL`	Cardiac
`BM`	Lymphatic
`BN`	Gastrointestinal
`BP`	Endocrine
`BQ`	Neurology
`BR`	Eye

Tip: If checking general eligibility, use code 30 (Health Benefit Plan Coverage). This returns overall plan information.

Relationship Codes

The MemberRelationship field uses standard X12 relationship codes:

Code	Relationship
`18`	Self (subscriber is the member)
`01`	Spouse
`19`	Child
`20`	Employee
`21`	Unknown
`39`	Organ Donor
`40`	Cadaver Donor
`53`	Life Partner
`G8`	Other Relationship

Default: If MemberRelationship is blank, the system assumes 18 (Self).

Validation Rules

The generator validates your CSV before creating the 270 file:

Format Validation

Field	Rule	Error Message
`MemberDOB`	Must be MM/DD/YYYY	"MemberDOB must be in MM/DD/YYYY format"
`ServiceDateFrom`	Must be MM/DD/YYYY	"ServiceDateFrom must be in MM/DD/YYYY format"
`MemberGender`	Must be M, F, or U	"MemberGender must be M, F, or U"
`ProviderNPI`	Must be 10 digits	"ProviderNPI must be 10 digits"
`MemberState`	Must be 2 letters	"MemberState must be 2-letter state code"
`MemberZip`	Must be 5 or 9 digits	"MemberZip must be 5 or 9 digits"

Required Field Validation

Condition	Error Message
Missing PayerID	"Row X: PayerID is required"
Missing MemberID	"Row X: MemberID is required"
Missing MemberLastName	"Row X: MemberLastName is required"
Missing MemberFirstName	"Row X: MemberFirstName is required"
Missing MemberDOB	"Row X: MemberDOB is required"
Missing ServiceTypeCode	"Row X: ServiceTypeCode is required"

Dependent Validation

Condition	Error Message
Relationship not "18" but missing SubscriberID	"Row X: SubscriberID required for dependent inquiries"
Relationship not "18" but missing SubscriberLastName	"Row X: SubscriberLastName required for dependent inquiries"

Date Validation

Condition	Warning Message
ServiceDateFrom in the past	"Row X: Service date is in the past"
ServiceDateTo before ServiceDateFrom	"Row X: ServiceDateTo must be after ServiceDateFrom"
MemberDOB in the future	"Row X: MemberDOB cannot be in the future"

Sample Templates

Basic Eligibility Check

Single subscriber, general coverage check:

csv

PayerID,PayerName,MemberID,MemberLastName,MemberFirstName,MemberDOB,ServiceTypeCode
BCBS01,Blue Cross Blue Shield,MEM123456789,Smith,John,03/15/1985,30

Multiple Service Types

Check multiple coverage types for one member:

csv

PayerID,PayerName,MemberID,MemberLastName,MemberFirstName,MemberDOB,ServiceTypeCode
BCBS01,Blue Cross Blue Shield,MEM123456789,Smith,John,03/15/1985,30
BCBS01,Blue Cross Blue Shield,MEM123456789,Smith,John,03/15/1985,88
BCBS01,Blue Cross Blue Shield,MEM123456789,Smith,John,03/15/1985,35

Checks: General coverage (30), Pharmacy (88), and Dental (35)

Subscriber with Dependent

Check eligibility for subscriber and their child:

csv

PayerID,PayerName,MemberID,MemberLastName,MemberFirstName,MemberDOB,MemberRelationship,SubscriberID,SubscriberLastName,SubscriberFirstName,SubscriberDOB,ServiceTypeCode
BCBS01,Blue Cross Blue Shield,MEM123456789,Smith,John,03/15/1985,18,,,,30
BCBS01,Blue Cross Blue Shield,MEM123456790,Smith,Emma,05/20/2015,19,MEM123456789,Smith,John,03/15/1985,30

Row 1: Subscriber (John Smith), Row 2: Dependent (Emma Smith, child)

Full Example with All Fields

csv

PayerID,PayerName,MemberID,MemberLastName,MemberFirstName,MemberMiddleName,MemberDOB,MemberGender,MemberAddress,MemberCity,MemberState,MemberZip,MemberRelationship,SubscriberID,SubscriberLastName,SubscriberFirstName,SubscriberDOB,ServiceTypeCode,CoverageLevel,ServiceDateFrom,ProviderNPI,ProviderName,TraceNumber
BCBS01,Blue Cross Blue Shield,MEM123456789,Smith,John,Robert,03/15/1985,M,123 Main St,Chicago,IL,60601,18,,,,,30,IND,02/01/2024,1234567890,ABC Medical Group,TRACE001
AETNA01,Aetna,AET987654321,Johnson,Mary,Ann,06/22/1990,F,456 Oak Ave,Boston,MA,02101,18,,,,,30,IND,02/01/2024,1234567890,ABC Medical Group,TRACE002
BCBS01,Blue Cross Blue Shield,MEM123456790,Smith,Emma,,05/20/2015,F,123 Main St,Chicago,IL,60601,19,MEM123456789,Smith,John,03/15/1985,30,IND,02/01/2024,1234567890,ABC Medical Group,TRACE003

Batch Processing Tips

Grouping Recommendations

For efficiency, the generator groups inquiries:

By Payer — All inquiries to the same payer go in one interchange
By Provider — All inquiries from the same provider NPI stay together
By Subscriber — Subscriber and their dependents are grouped

Trace Numbers

Use unique TraceNumber values for each row
The trace number appears in the 271 response
Helps you match responses to original inquiries

File Size Limits

Tier	Max Rows	Max Inquiries per 270
Free	50	50
Pro	500	500
Enterprise	Unlimited	1,000 per file

Error Handling

CSV Parse Errors

Error	Cause	Solution
"Unexpected end of input"	Missing closing quote	Check quoted fields
"Invalid CSV format"	Inconsistent column count	Ensure all rows have same columns
"Empty file"	No data rows	Add at least one data row

Validation Errors

Validation errors prevent file generation. Fix all errors before retrying.

Warnings

Warnings don't block generation but may indicate data quality issues. Review and fix if necessary.

Generated 270 Structure

Your CSV generates a 270 with this structure:

ISA...                           (Interchange Header)
  GS*HS...                       (Functional Group - HS = Eligibility)
    ST*270...                    (Transaction Set Header)
      BHT*0022*13*...            (Beginning of Hierarchical Transaction)
      HL*1**20*1~                (Information Source - Provider)
        NM1*1P*...               (Provider Name/NPI)
      HL*2*1*21*1~               (Information Receiver - Payer)
        NM1*PR*...               (Payer Name/ID)
      HL*3*2*22*1~               (Subscriber)
        TRN*1*{TraceNumber}*...  (Trace Number)
        NM1*IL*...               (Subscriber Name/ID)
        DMG*D8*{DOB}*{Gender}~   (Demographics)
        DTP*291*D8*{Date}~       (Service Date)
        EQ*{ServiceTypeCode}~    (Eligibility Inquiry)
      HL*4*3*23*0~               (Dependent, if any)
        TRN*1*{TraceNumber}*...
        NM1*03*...               (Dependent Name)
        ...
    SE...                        (Transaction Set Trailer)
  GE...                          (Functional Group Trailer)
IEA...                           (Interchange Trailer)

Downloadable Templates

Basic Template (3 columns) — Minimum required fields
Standard Template (12 columns) — Common fields
Full Template (all columns) — All available fields

270 Eligibility Inquiry — Understanding 270 structure
271 Eligibility Response — Understanding responses
Eligibility Summaries — Reading eligibility data

270 CSV Schema ​

Quick Start ​

CSV Structure ​

Row Types ​

Required Fields ​

Why These Are Required ​

Optional Fields ​

Member Information ​

Subscriber Information (when different from member) ​

Service Inquiry Details ​

Provider Information ​

Tracking ​

Service Type Codes ​

Common Codes ​

Additional Codes ​

Relationship Codes ​

Validation Rules ​

Format Validation ​

Required Field Validation ​

Dependent Validation ​

Date Validation ​

Sample Templates ​

Basic Eligibility Check ​

Multiple Service Types ​

Subscriber with Dependent ​

Full Example with All Fields ​

Batch Processing Tips ​

Grouping Recommendations ​

Trace Numbers ​

File Size Limits ​

Error Handling ​

CSV Parse Errors ​

Validation Errors ​

Warnings ​

Generated 270 Structure ​

Downloadable Templates ​

Related Documentation ​