EDI 270 Data Transformation Documentation

EDI 270 Data Transformation

Create and transform EDI messages using one of our two supported JSON formats.

Our current supported EDI version: 005010

Need help with some of our documentation? Feel free to contact our support team, and one of our support team members will be happy to assist you.

Smart JSON Request to EDI 270 Response

Transforms the Smart JSON into an EDI 270 message. Recommended unless you need specific requirements that the Smart JSON may not support.

post https://api-edi.splinxtechnologies.com/v1/edi-transformation/smart-to-edi270

Request headers

Authentication

To make REST API calls, make sure to include your account's email and password in a Base64 encrypted format in the Basic authentication scheme. The value is <Account-Email> and <Account-Password>

LicenseId

Request fields

Field

Description

MemberProfileList required

List<MemberProfile> represents each member, which is the subscriber or dependent. Use class MemberProfile for reference.

TransactionDate required

string<mm/dd/yy> represents the date at which the transaction is sent.

SenderTradingPartnerId required

string<2-15 characters> represents the sending trading partner id.

SenderTradingPartnerIdQualifier required

string<2 characters> represents the sending trading partner id type. Use table EDI Trading Partner Id Qualifiers for reference.

ReceiverTradingPartnerId required

string<2-15 characters> represents the receiving trading partner id.

ReceiverTradingPartnerIdQualifier required

string<2 characters> represents the receiving trading partner id type. Use table EDI Trading Partner Id Qualifiers for reference.

ProviderFirstName optional

string<1-35 characters> represents the provider's first name who is verifying the patient's eligibility. Only send if the provider is verifying the eligibility.

ProviderLastNameOrOrganizationName required

string<1-60 characters> represents the provider's last name or the organization's name, depending on which entity is verifying the patient eligibility.

OrganizationTypeCode required

string represents the type of entity that is making the request. Use table EDI Entity Identifier Codes for reference.

OrganizationIdentifierType required

string represents the type of identification for the entity that is making the request. Use table EDI Identification Code Identifiers for reference.

OrganizationIdentifier required

string<2-80 characters> represents the identification for the entity that is making the request.

PayerIdCodeQualifier required

string<1-2 characters> represents the type of payer or insurance that is being sent. Use table EDI Identification Code Identifiers for reference.

PayerId required

string<2-80 characters> represents the id of the payer or insurance.

ServiceTypeCodes optional

List<string> represents any service codes to send in the request that may be used for more accurate verification of eligibility. If left empty, default value is 30. Use table EDI Service Type Codes for reference.

Sample request

Smart JSON Copy

{
  "MemberProfileList": [
    {
      "FirstName": "Robert",
      "LastName": "Smith",
      "BirthDate": "03/15/1969",
      "StreetAddress": "",
      "City": "",
      "State": "",
      "ZipCode": "",
      "InsuredId": "",
      "SSN": "",
      "TraceReferenceId": "1234",
      "EligibilityDate": "07/22/2023"
    }
  ],
  "TransactionDate": "07/22/2023",
  "SenderTradingPartnerId": "200000500",
  "SenderTradingPartnerIdQualifier": "ZZ",
  "ReceiverTradingPartnerId": "440000161",
  "ReceiverTradingPartnerIdQualifier": "ZZ",
  "EligibilityDate": "07/22/2023",
  "ProviderLastNameOrOrganizationName": "Sample, Inc.",
  "OrganizationTypeCode": "1P",
  "OrganizationIdentifierType": "XX",
  "OrganizationIdentifier": "1100463840",
  "PayerIdCodeQualifier": "PI",
  "PayerName": "Sample",
  "PayerId": "75-2548221",
  "ServiceTypeCodes": [
    "1",
    "30"
  ]
}

Sample response

EDI 270 Copy

ISA*00*          *00*          *ZZ*200000500      *ZZ*440000161      *230722*0000*^*00501*000000001*0*P*:~GS*HS*200000500*440000161*20230722*0000*1*X*005010X279A1~ST*270*0001*005010X279A1~BHT*0022*13**20230722*0000~HL*1**20*1~NM1*PR*2*Sample*****PI*75-2548221~HL*2*1*21*1~NM1*1P*2*Sample, Inc.*****XX*1100463840~HL*3*2*22*0~TRN*1*1234*1100463840~NM1*IL*1*SMITH*ROBERT~DMG*D8*19690315~DTP*291*D8*20230722~EQ*1^30~SE*13*0001~GE*1*1~IEA*1*000000001~

EDI 270 Request to JSON Response

Transforms an EDI 270 message into JSON.

post https://api-edi.splinxtechnologies.com/v1/edi-transformation/edi270-to-json

Request headers

Authentication

To make REST API calls, make sure to include your account's email and password in a Base64 encrypted format in the Basic authentication scheme. The value is <Account-Email> and <Account-Password>

LicenseId

Sample request

EDI 270 Copy

ISA*00*          *00*          *ZZ*SUBMITTERS ID  *ZZ*RECEIVERS ID   *220412*1253*^*00501*000000001*0*P*:~GS*HS*SENDER CODE*RECEIVER CODE*20220412*1513*002*X*005010X279A1~ST*270*1234*005010X279A1~BHT*0022*13*10001234*20060501*1319~HL*1**20*1~NM1*PR*2*ABC COMPANY*****PI*842610001~HL*2*1*21*1~NM1*1P*2*BONE AND JOINT CLINIC*****SV*2000035~HL*3*2*22*0~TRN*1*93175-012547*9877281234~NM1*IL*1*SMITH*ROBERT****MI*11122333301~DMG*D8*19430519~DTP*291*D8*20060501~EQ*30~SE*13*1234~GE*1*002~IEA*1*000000001~

Sample response

JSON Copy

{
  "InterchangeControlHeaderSegment": {
    "ISA_01_AuthorizationInformationQualifier_ID": "00",
    "ISA_02_AuthorizationInformation_AN": "          ",
    "ISA_03_SecurityInformationQualifier_ID": "00",
    "ISA_04_SecurityInformation_AN": "          ",
    "ISA_05_InterchangeIDQualifier_ID": "ZZ",
    "ISA_06_InterchangeSenderID_AN": "SUBMITTERS ID  ",
    "ISA_07_InterchangeIDQualifier_ID": "ZZ",
    "ISA_08_InterchangeReceiverID_AN": "RECEIVERS ID   ",
    "ISA_09_InterchangeDate_DT": "220412",
    "ISA_10_InterchangeTime_TM": "1253",
    "ISA_11_RepetitionSeparator": "^",
    "ISA_12_InterchangeControlVersionNumber_ID": "00501",
    "ISA_13_InterchangeControlNumber_N": "000000001",
    "ISA_14_AcknowledgmentRequest_ID": "0",
    "ISA_15_InterchangeUsageIndicator_ID": "P",
    "ISA_16_ComponentElementSeparator": ":"
  },
  "FunctionalGroups": [
    {
      "FunctionalGroupHeaderSegment": {
        "GS_01_FunctionalIdentifierCode_ID": "HS",
        "GS_02_ApplicationSendersCode_AN": "SENDER CODE",
        "GS_03_ApplicationReceiversCode_AN": "RECEIVER CODE",
        "GS_04_Date_DT": "20220412",
        "GS_05_Time_TM": "1513",
        "GS_06_GroupControlNumber_N": "002",
        "GS_07_ResponsibleAgencyCode_ID": "X",
        "GS_08_VersionReleaseIndustryIdentifierCode_AN": "005010X279A1"
      },
      "TransactionSets": [
        {
          "TransactionSetHeader": {
            "ST_01_TransactionSetIdentifierCode_ID": "270",
            "ST_02_TransactionSetControlNumber_AN": "1234",
            "ST_03_ImplementationConventionReference_AN": "005010X279A1"
          },
          "BeginningOfHierarchicalTransaction": {
            "BHT_01_HierarchicalStructureCode_ID": "0022",
            "BHT_02_TransactionSetPurposeCode_ID": "13",
            "BHT_03_ReferenceIdentification_AN": "10001234",
            "BHT_04_Date_DT": "20060501",
            "BHT_05_Time_TM": "1319",
            "BHT_06_TransactionTypeCode_ID": null
          },
          "InformationSourceLevel_Loop_2000A": [
            {
              "InformationSourceLevel": {
                "HL_01_HierarchicalIDNumber_AN": "1",
                "HL_02_HierarchicalParentIDNumber_AN": null,
                "HL_03_HierarchicalLevelCode_ID": "20",
                "HL_04_HierarchicalChildCode_ID": "1"
              },
              "InformationSourceName_Loop_2100A": {
                "InformationSourceName": {
                  "NM1_01_EntityIdentifierCode_ID": "PR",
                  "NM1_02_EntityTypeQualifier_ID": "2",
                  "NM1_03_NameLastOrOrganizationName_AN": "ABC COMPANY",
                  "NM1_04_NameFirst_AN": null,
                  "NM1_05_NameMiddle_AN": null,
                  "NM1_06_NamePrefix_AN": null,
                  "NM1_07_NameSuffix_AN": null,
                  "NM1_08_IdentificationCodeQualifier_ID": "PI",
                  "NM1_09_IdentificationCode_AN": "842610001",
                  "NM1_10_EntityRelationshipCode_ID": null,
                  "NM1_11_EntityIdentifierCode_ID": null,
                  "NM1_12_NameLastOrOrganizationName_AN": null
                }
              }
            }
          ],
          "InformationReceiverLevel_Loop_2000B": [
            {
              "InformationReceiverLevel": {
                "HL_01_HierarchicalIDNumber_AN": "2",
                "HL_02_HierarchicalParentIDNumber_AN": "1",
                "HL_03_HierarchicalLevelCode_ID": "21",
                "HL_04_HierarchicalChildCode_ID": "1"
              },
              "InformationReceiverName_Loop_2100B": {
                "InformationReceiverName": {
                  "NM1_01_EntityIdentifierCode_ID": "1P",
                  "NM1_02_EntityTypeQualifier_ID": "2",
                  "NM1_03_NameLastOrOrganizationName_AN": "BONE AND JOINT CLINIC",
                  "NM1_04_NameFirst_AN": null,
                  "NM1_05_NameMiddle_AN": null,
                  "NM1_06_NamePrefix_AN": null,
                  "NM1_07_NameSuffix_AN": null,
                  "NM1_08_IdentificationCodeQualifier_ID": "SV",
                  "NM1_09_IdentificationCode_AN": "2000035",
                  "NM1_10_EntityRelationshipCode_ID": null,
                  "NM1_11_EntityIdentifierCode_ID": null,
                  "NM1_12_NameLastOrOrganizationName_AN": null
                },
                "InformationReceiverAdditionalIdentification": null,
                "InformationReceiverAddress": null,
                "InformationReceiverCityStateZipCode": null,
                "InformationReceiverProviderInformation": null
              }
            }
          ],
          "SubscriberLevel_Loop_2000C": [
            {
              "SubscriberLevel": {
                "HL_01_HierarchicalIDNumber_AN": "3",
                "HL_02_HierarchicalParentIDNumber_AN": "2",
                "HL_03_HierarchicalLevelCode_ID": "22",
                "HL_04_HierarchicalChildCode_ID": "0"
              },
              "SubscriberTraceNumber": [
                {
                  "TRN_01_TraceTypeCode_ID": "1",
                  "TRN_02_ReferenceIdentification_AN": "93175-012547",
                  "TRN_03_OriginatingCompanyIdentifier_AN": "9877281234",
                  "TRN_04_ReferenceIdentification_AN": null
                }
              ],
              "SubscriberName_Loop_2100C": {
                "SubscriberName": {
                  "NM1_01_EntityIdentifierCode_ID": "IL",
                  "NM1_02_EntityTypeQualifier_ID": "1",
                  "NM1_03_NameLastOrOrganizationName_AN": "SMITH",
                  "NM1_04_NameFirst_AN": "ROBERT",
                  "NM1_05_NameMiddle_AN": null,
                  "NM1_06_NamePrefix_AN": null,
                  "NM1_07_NameSuffix_AN": null,
                  "NM1_08_IdentificationCodeQualifier_ID": "MI",
                  "NM1_09_IdentificationCode_AN": "11122333301",
                  "NM1_10_EntityRelationshipCode_ID": null,
                  "NM1_11_EntityIdentifierCode_ID": null,
                  "NM1_12_NameLastOrOrganizationName_AN": null
                },
                "SubscriberAdditionalIdentification": null,
                "SubscriberAddress": null,
                "SubscriberCityStateZipCode": null,
                "ProviderInformation": null,
                "SubscriberDemographicInformation": {
                  "DMG_01_DateTimePeriodFormatQualifier_ID": "D8",
                  "DMG_02_DateTimePeriod_AN": "19430519",
                  "DMG_03_GenderCode_ID": null,
                  "DMG_04_MaritalStatusCode_ID": null,
                  "DMG_05_CompositeRaceOrEthnicityInformation": null,
                  "DMG_06_CitizenshipStatusCode_ID": null,
                  "DMG_07_CountryCode_ID": null,
                  "DMG_08_BasisOfVerificationCode_ID": null,
                  "DMG_09_Quantity_R": null,
                  "DMG_10_CodeListQualifierCode_ID": null,
                  "DMG_11_IndustryCode_AN": null
                },
                "MultipleBirthSequenceNumber": null,
                "SubscriberHealthCareDiagnosisCode": null,
                "SubscriberDate": [
                  {
                    "DTP_01_DateTimeQualifier_ID": "291",
                    "DTP_02_DateTimePeriodFormatQualifier_ID": "D8",
                    "DTP_03_DateTimePeriod_AN": "20060501"
                  }
                ],
                "SubscriberEligibilityOrBenefitInquiry_Loop_2110C": [
                  {
                    "SubscriberEligibilityOrBenfitInquiry": {
                      "EQ_01_ServiceTypeCode_ID": [
                        "30"
                      ],
                      "EQ_02_CompositeMedicalProcedureIdentifier": null,
                      "EQ_03_CoverageLevelCode_ID": null,
                      "EQ_04_InsuranceTypeCode_ID": null,
                      "EQ_05_CompositeDiagnosisCodePointer": null
                    },
                    "SubscriberSpendDownAmount": null,
                    "SubscriberSpendDownTotalBilledAmount": null,
                    "SubscriberEligibilityOrBenefitAdditionalInquiryInformation": null,
                    "SubscriberAdditionalInformation": null,
                    "SubscriberEligibilityBenefitDate": null
                  }
                ]
              }
            }
          ],
          "DependentLevel_Loop_2000D": [
            {
              "DependentLevel": null,
              "DependentTraceNumber": null,
              "DependentName_Loop_2100D": {
                "DependentName": null,
                "DependentAdditionalIdentification": null,
                "DependentAddress": null,
                "DependentCityStateZipCode": null,
                "ProviderInformation": null,
                "DependentDemographicInformation": null,
                "DependentRelationship": null,
                "DependentHealthCareDiagnosisCode": null,
                "DependentDate": null,
                "DependentEligibiityOrBenefitInquiry_Loop_2110D": [
                  {
                    "DependentEligibilityOrBenefitInquiry": null,
                    "DependentEligibilityOrBenefitAdditionalInquiryInformation": null,
                    "DependentAdditionalInformation": null,
                    "DependentEligibilityBenefitDate": null
                  }
                ]
              }
            }
          ],
          "TransactionSetTrailer": {
            "SE_01_NumberOfIncludedSegments_N": "13",
            "SE_02_TransactionSetControlNumber_AN": "1234"
          }
        }
      ],
      "FunctionalGroupTrailerSegment": {
        "GE_01_NumberOfTransactionSetsIncluded_N": "1",
        "GE_02_GroupControlNumber_N": "002"
      }
    }
  ],
  "InterchangeControlTrailerSegment": {
    "IEA_01_NumberOfIncludedFunctionalGroups_N": "1",
    "IEA_02_InterchangeControlNumber_N": "000000001"
  }
}

JSON Request to EDI 270 Response

Transforms JSON into an EDI 270 message.

post https://api-edi.splinxtechnologies.com/v1/edi-transformation/json-to-edi270

Request headers

Authentication

To make REST API calls, make sure to include your account's email and password in a Base64 encrypted format in the Basic authentication scheme. The value is <Account-Email> and <Account-Password>

LicenseId

Sample request

JSON Copy

{
  "InterchangeControlHeaderSegment": {
    "ISA_01_AuthorizationInformationQualifier_ID": "00",
    "ISA_02_AuthorizationInformation_AN": "          ",
    "ISA_03_SecurityInformationQualifier_ID": "00",
    "ISA_04_SecurityInformation_AN": "          ",
    "ISA_05_InterchangeIDQualifier_ID": "ZZ",
    "ISA_06_InterchangeSenderID_AN": "SUBMITTERS ID  ",
    "ISA_07_InterchangeIDQualifier_ID": "ZZ",
    "ISA_08_InterchangeReceiverID_AN": "RECEIVERS ID   ",
    "ISA_09_InterchangeDate_DT": "220412",
    "ISA_10_InterchangeTime_TM": "1253",
    "ISA_11_RepetitionSeparator": "^",
    "ISA_12_InterchangeControlVersionNumber_ID": "00501",
    "ISA_13_InterchangeControlNumber_N": "000000001",
    "ISA_14_AcknowledgmentRequest_ID": "0",
    "ISA_15_InterchangeUsageIndicator_ID": "P",
    "ISA_16_ComponentElementSeparator": ":"
  },
  "FunctionalGroups": [
    {
      "FunctionalGroupHeaderSegment": {
        "GS_01_FunctionalIdentifierCode_ID": "HS",
        "GS_02_ApplicationSendersCode_AN": "SENDER CODE",
        "GS_03_ApplicationReceiversCode_AN": "RECEIVER CODE",
        "GS_04_Date_DT": "20220412",
        "GS_05_Time_TM": "1513",
        "GS_06_GroupControlNumber_N": "002",
        "GS_07_ResponsibleAgencyCode_ID": "X",
        "GS_08_VersionReleaseIndustryIdentifierCode_AN": "005010X279A1"
      },
      "TransactionSets": [
        {
          "TransactionSetHeader": {
            "ST_01_TransactionSetIdentifierCode_ID": "270",
            "ST_02_TransactionSetControlNumber_AN": "1234",
            "ST_03_ImplementationConventionReference_AN": "005010X279A1"
          },
          "BeginningOfHierarchicalTransaction": {
            "BHT_01_HierarchicalStructureCode_ID": "0022",
            "BHT_02_TransactionSetPurposeCode_ID": "13",
            "BHT_03_ReferenceIdentification_AN": "10001234",
            "BHT_04_Date_DT": "20060501",
            "BHT_05_Time_TM": "1319",
            "BHT_06_TransactionTypeCode_ID": null
          },
          "InformationSourceLevel_Loop_2000A": [
            {
              "InformationSourceLevel": {
                "HL_01_HierarchicalIDNumber_AN": "1",
                "HL_02_HierarchicalParentIDNumber_AN": null,
                "HL_03_HierarchicalLevelCode_ID": "20",
                "HL_04_HierarchicalChildCode_ID": "1"
              },
              "InformationSourceName_Loop_2100A": {
                "InformationSourceName": {
                  "NM1_01_EntityIdentifierCode_ID": "PR",
                  "NM1_02_EntityTypeQualifier_ID": "2",
                  "NM1_03_NameLastOrOrganizationName_AN": "ABC COMPANY",
                  "NM1_04_NameFirst_AN": null,
                  "NM1_05_NameMiddle_AN": null,
                  "NM1_06_NamePrefix_AN": null,
                  "NM1_07_NameSuffix_AN": null,
                  "NM1_08_IdentificationCodeQualifier_ID": "PI",
                  "NM1_09_IdentificationCode_AN": "842610001",
                  "NM1_10_EntityRelationshipCode_ID": null,
                  "NM1_11_EntityIdentifierCode_ID": null,
                  "NM1_12_NameLastOrOrganizationName_AN": null
                }
              }
            }
          ],
          "InformationReceiverLevel_Loop_2000B": [
            {
              "InformationReceiverLevel": {
                "HL_01_HierarchicalIDNumber_AN": "2",
                "HL_02_HierarchicalParentIDNumber_AN": "1",
                "HL_03_HierarchicalLevelCode_ID": "21",
                "HL_04_HierarchicalChildCode_ID": "1"
              },
              "InformationReceiverName_Loop_2100B": {
                "InformationReceiverName": {
                  "NM1_01_EntityIdentifierCode_ID": "1P",
                  "NM1_02_EntityTypeQualifier_ID": "2",
                  "NM1_03_NameLastOrOrganizationName_AN": "BONE AND JOINT CLINIC",
                  "NM1_04_NameFirst_AN": null,
                  "NM1_05_NameMiddle_AN": null,
                  "NM1_06_NamePrefix_AN": null,
                  "NM1_07_NameSuffix_AN": null,
                  "NM1_08_IdentificationCodeQualifier_ID": "SV",
                  "NM1_09_IdentificationCode_AN": "2000035",
                  "NM1_10_EntityRelationshipCode_ID": null,
                  "NM1_11_EntityIdentifierCode_ID": null,
                  "NM1_12_NameLastOrOrganizationName_AN": null
                },
                "InformationReceiverAdditionalIdentification": null,
                "InformationReceiverAddress": null,
                "InformationReceiverCityStateZipCode": null,
                "InformationReceiverProviderInformation": null
              }
            }
          ],
          "SubscriberLevel_Loop_2000C": [
            {
              "SubscriberLevel": {
                "HL_01_HierarchicalIDNumber_AN": "3",
                "HL_02_HierarchicalParentIDNumber_AN": "2",
                "HL_03_HierarchicalLevelCode_ID": "22",
                "HL_04_HierarchicalChildCode_ID": "0"
              },
              "SubscriberTraceNumber": [
                {
                  "TRN_01_TraceTypeCode_ID": "1",
                  "TRN_02_ReferenceIdentification_AN": "93175-012547",
                  "TRN_03_OriginatingCompanyIdentifier_AN": "9877281234",
                  "TRN_04_ReferenceIdentification_AN": null
                }
              ],
              "SubscriberName_Loop_2100C": {
                "SubscriberName": {
                  "NM1_01_EntityIdentifierCode_ID": "IL",
                  "NM1_02_EntityTypeQualifier_ID": "1",
                  "NM1_03_NameLastOrOrganizationName_AN": "SMITH",
                  "NM1_04_NameFirst_AN": "ROBERT",
                  "NM1_05_NameMiddle_AN": null,
                  "NM1_06_NamePrefix_AN": null,
                  "NM1_07_NameSuffix_AN": null,
                  "NM1_08_IdentificationCodeQualifier_ID": "MI",
                  "NM1_09_IdentificationCode_AN": "11122333301",
                  "NM1_10_EntityRelationshipCode_ID": null,
                  "NM1_11_EntityIdentifierCode_ID": null,
                  "NM1_12_NameLastOrOrganizationName_AN": null
                },
                "SubscriberAdditionalIdentification": null,
                "SubscriberAddress": null,
                "SubscriberCityStateZipCode": null,
                "ProviderInformation": null,
                "SubscriberDemographicInformation": {
                  "DMG_01_DateTimePeriodFormatQualifier_ID": "D8",
                  "DMG_02_DateTimePeriod_AN": "19430519",
                  "DMG_03_GenderCode_ID": null,
                  "DMG_04_MaritalStatusCode_ID": null,
                  "DMG_05_CompositeRaceOrEthnicityInformation": null,
                  "DMG_06_CitizenshipStatusCode_ID": null,
                  "DMG_07_CountryCode_ID": null,
                  "DMG_08_BasisOfVerificationCode_ID": null,
                  "DMG_09_Quantity_R": null,
                  "DMG_10_CodeListQualifierCode_ID": null,
                  "DMG_11_IndustryCode_AN": null
                },
                "MultipleBirthSequenceNumber": null,
                "SubscriberHealthCareDiagnosisCode": null,
                "SubscriberDate": [
                  {
                    "DTP_01_DateTimeQualifier_ID": "291",
                    "DTP_02_DateTimePeriodFormatQualifier_ID": "D8",
                    "DTP_03_DateTimePeriod_AN": "20060501"
                  }
                ],
                "SubscriberEligibilityOrBenefitInquiry_Loop_2110C": [
                  {
                    "SubscriberEligibilityOrBenfitInquiry": {
                      "EQ_01_ServiceTypeCode_ID": [
                        "30"
                      ],
                      "EQ_02_CompositeMedicalProcedureIdentifier": null,
                      "EQ_03_CoverageLevelCode_ID": null,
                      "EQ_04_InsuranceTypeCode_ID": null,
                      "EQ_05_CompositeDiagnosisCodePointer": null
                    },
                    "SubscriberSpendDownAmount": null,
                    "SubscriberSpendDownTotalBilledAmount": null,
                    "SubscriberEligibilityOrBenefitAdditionalInquiryInformation": null,
                    "SubscriberAdditionalInformation": null,
                    "SubscriberEligibilityBenefitDate": null
                  }
                ]
              }
            }
          ],
          "DependentLevel_Loop_2000D": [
            {
              "DependentLevel": null,
              "DependentTraceNumber": null,
              "DependentName_Loop_2100D": {
                "DependentName": null,
                "DependentAdditionalIdentification": null,
                "DependentAddress": null,
                "DependentCityStateZipCode": null,
                "ProviderInformation": null,
                "DependentDemographicInformation": null,
                "DependentRelationship": null,
                "DependentHealthCareDiagnosisCode": null,
                "DependentDate": null,
                "DependentEligibiityOrBenefitInquiry_Loop_2110D": [
                  {
                    "DependentEligibilityOrBenefitInquiry": null,
                    "DependentEligibilityOrBenefitAdditionalInquiryInformation": null,
                    "DependentAdditionalInformation": null,
                    "DependentEligibilityBenefitDate": null
                  }
                ]
              }
            }
          ],
          "TransactionSetTrailer": {
            "SE_01_NumberOfIncludedSegments_N": "13",
            "SE_02_TransactionSetControlNumber_AN": "1234"
          }
        }
      ],
      "FunctionalGroupTrailerSegment": {
        "GE_01_NumberOfTransactionSetsIncluded_N": "1",
        "GE_02_GroupControlNumber_N": "002"
      }
    }
  ],
  "InterchangeControlTrailerSegment": {
    "IEA_01_NumberOfIncludedFunctionalGroups_N": "1",
    "IEA_02_InterchangeControlNumber_N": "000000001"
  }
}

Sample response

EDI 270 Copy

ISA*00*          *00*          *ZZ*SUBMITTERS ID  *ZZ*RECEIVERS ID   *220412*1253*^*00501*000000001*0*P*:~GS*HS*SENDER CODE*RECEIVER CODE*20220412*1513*002*X*005010X279A1~ST*270*1234*005010X279A1~BHT*0022*13*10001234*20060501*1319~HL*1**20*1~NM1*PR*2*ABC COMPANY*****PI*842610001~HL*2*1*21*1~NM1*1P*2*BONE AND JOINT CLINIC*****SV*2000035~HL*3*2*22*0~TRN*1*93175-012547*9877281234~NM1*IL*1*SMITH*ROBERT****MI*11122333301~DMG*D8*19430519~DTP*291*D8*20060501~EQ*30~SE*13*1234~GE*1*002~IEA*1*000000001~

MemberProfile fields

Field

Description

FirstName required

string<1-35 characters>

LastName required

string<1-60 characters>

BirthDate required

string<mm/dd/yy>

StreetAddress optional

string<1-55 characters>

City optional

string<2-30 characters>

State optional

string<2 characters>

ZipCode optional

string<5-15 characters>

InsuredId optional

string<2-80 characters> represents the subscriber insurance identification.

SSN optional

string

TraceReferenceId optional

string<1-50 characters> represents what value will be sent back in the response.

EligibilityDate required

string<mm/dd/yy>

Healthcare EDIs

EDI 270 SJ (Patient Eligibility Request)

EDI 271 SJ (Patient Eligibility Request)

EDI 276 (Claim Status Request)

EDI 277 (Claim Status Response)

EDI 834 (Patient Enrollment)

EDI 835 SJ (Claim Payment and Advice)

EDI 837 (Claims)

Acknowledgment EDIs

EDI 997 SJ (Functional Acknowledgment)

EDI 999 SJ (Implementation Acknowledgment)

Freight and Shipping EDIs

EDI 404 (Rail Carrier Shipment Information)

EDI 410 (Rail Carrier Freight Details and Invoice)