EDI 271 Data Transformation Documentation

EDI 271 Data Transformation

Transform and create 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.

EDI 271 Request to Smart JSON Response

Transforms the EDI 271 message into our Smart JSON format. Recommended unless you need specific requirements that the Smart JSON may not support.

post https://api-edi.splinxtechnologies.com/v1/edi-transformation/edi271-to-smart

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

Response fields

Field

Description

IsRejected

boolean represents whether the request was rejected.

RejectReason

List<string> represents the reasons for rejection.

EligibilityOrBenefitSourceInformation

List<EligibilityOrBenefitSource> represents the party that verifies the eligibility. Use class EligibilityOrBenefitSource for reference.

Subscriber

MemberProfile represents the subscriber. Use class MemberProfile for reference.

Dependent

MemberProfile represents the dependent. Use class MemberProfile for reference.

SubscriberEligibilityOrBenefitInformation

List<EligibilityOrBenefitInformation> represents the subscriber's eligibility or benefit information. Use class EligibilityOrBenefitInformation for reference.

DependentEligibilityOrBenefitInformation

List<EligibilityOrBenefitInformation> represents the dependent's eligibility or benefit information. Use class EligibilityOrBenefitInformation for reference.

Sample request

EDI 271 Copy

ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *220610*1300*^*00501*161130044*0*P*:~GS*HB*SENDER*RECEIVER*20220610*1300*1*X*005010X279A1~ST*271*4321*005010X279A1~BHT*0022*11*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*2*93175-012547*9877281234~NM1*IL*1*SMITH*JOHN****MI*123456789~N3*15197 BROADWAY AVENUE*APT 215~N4*KANSAS CITY*MO*64108~DMG*D8*19630519*M~DTP*346*D8*20060101~EB*1**30**GOLD 123 PLAN~EB*L~LS*2120~NM1*P3*1*JONES*MARCUS****SV*0202034~LE*2120~EB*1**1^33^35^47^86^88^98^AL^MH^UC~EB*B**1^33^35^47^86^88^98^AL^MH^UC*HM*GOLD 123 PLAN*27*10*****Y~EB*B**1^33^35^47^86^88^98^AL^MH^UC*HM*GOLD 123 PLAN*27*30*****N~SE*22*4321~GE*2*1~IEA*1*161130044~

Sample response

Smart JSON Copy

[
  {
    "IsRejected": false,
    "EligibilityOrBenefitSourceInformation": [
      {
        "EligibilityOrBenefitSourceType": "Payer",
        "EligibilityOrBenefitSourceName": "ABC COMPANY"
      }
    ],
    "Subscriber": {
      "FirstName": "JOHN",
      "LastName": "SMITH",
      "BirthDate": "05/19/1963",
      "StreetAddress": "15197 BROADWAY AVENUE",
      "City": "KANSAS CITY",
      "State": "MO",
      "ZipCode": "64108",
      "InsuredId": "123456789",
      "TraceReferenceId": "93175-012547"
    },
    "SubscriberEligibilityOrBenefitInformation": [
      {
        "EligibilityOrBenefitInformationDescription": "Active Coverage",
        "ServiceTypes": [
          "Health Benefit Plan Coverage"
        ],
        "PlanCoverageDescription": "GOLD 123 PLAN",
        "EligibilityOrBenefitDates": [
          {
            "EligibilityOrBenefitDateQualifier": "Plan Begin",
            "EligibilityOrBenefitDateTime": "01/01/2006"
          }
        ]
      },
      {
        "EligibilityOrBenefitInformationDescription": "Primary Care Provider",
        "BenefitRelatedEntityNames": [
          {
            "EntityDescription": "Primary Care Provider",
            "Name": "JONES MARCUS"
          }
        ]
      },
      {
        "EligibilityOrBenefitInformationDescription": "Active Coverage",
        "ServiceTypes": [
          "Medical Care",
          "Chiropractic",
          "Dental Care",
          "Hospital",
          "Emergency Services",
          "Pharmacy",
          "Professional (Physician) Visit – Office",
          "Vision (Optometry)",
          "Mental Health",
          "Urgent Care"
        ]
      },
      {
        "EligibilityOrBenefitInformationDescription": "Co-Payment",
        "ServiceTypes": [
          "Medical Care",
          "Chiropractic",
          "Dental Care",
          "Hospital",
          "Emergency Services",
          "Pharmacy",
          "Professional (Physician) Visit – Office",
          "Vision (Optometry)",
          "Mental Health",
          "Urgent Care"
        ],
        "InsuranceTypeDescription": "Health Maintenance Organization (HMO)",
        "PlanCoverageDescription": "GOLD 123 PLAN",
        "CoveredAmount": "10",
        "TimePeriodQualifier": "Visit",
        "InNetwork": "Yes"
      },
      {
        "EligibilityOrBenefitInformationDescription": "Co-Payment",
        "ServiceTypes": [
          "Medical Care",
          "Chiropractic",
          "Dental Care",
          "Hospital",
          "Emergency Services",
          "Pharmacy",
          "Professional (Physician) Visit – Office",
          "Vision (Optometry)",
          "Mental Health",
          "Urgent Care"
        ],
        "InsuranceTypeDescription": "Health Maintenance Organization (HMO)",
        "PlanCoverageDescription": "GOLD 123 PLAN",
        "CoveredAmount": "30",
        "TimePeriodQualifier": "Visit",
        "InNetwork": "No"
      }
    ]
  }
]

EDI 271 Request to JSON Response

Transforms an EDI 271 message into JSON.

post https://api-edi.splinxtechnologies.com/v1/edi-transformation/edi271-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 271 Copy

ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *220610*1300*^*00501*161130044*0*P*:~GS*HB*SENDER*RECEIVER*20220610*1300*1*X*005010X279A1~ST*271*4321*005010X279A1~BHT*0022*11*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*2*93175-012547*9877281234~NM1*IL*1*SMITH*JOHN****MI*123456789~N3*15197 BROADWAY AVENUE*APT 215~N4*KANSAS CITY*MO*64108~DMG*D8*19630519*M~DTP*346*D8*20060101~EB*1**30**GOLD 123 PLAN~EB*L~LS*2120~NM1*P3*1*JONES*MARCUS****SV*0202034~LE*2120~EB*1**1^33^35^47^86^88^98^AL^MH^UC~EB*B**1^33^35^47^86^88^98^AL^MH^UC*HM*GOLD 123 PLAN*27*10*****Y~EB*B**1^33^35^47^86^88^98^AL^MH^UC*HM*GOLD 123 PLAN*27*30*****N~SE*22*4321~GE*2*1~IEA*1*161130044~

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": "SENDER         ",
    "ISA_07_InterchangeIDQualifier_ID": "ZZ",
    "ISA_08_InterchangeReceiverID_AN": "RECEIVER       ",
    "ISA_09_InterchangeDate_DT": "220610",
    "ISA_10_InterchangeTime_TM": "1300",
    "ISA_11_RepetitionSeparator": "^",
    "ISA_12_InterchangeControlVersionNumber_ID": "00501",
    "ISA_13_InterchangeControlNumber_N": "161130044",
    "ISA_14_AcknowledgmentRequest_ID": "0",
    "ISA_15_InterchangeUsageIndicator_ID": "P",
    "ISA_16_ComponentElementSeparator": ":"
  },
  "FunctionalGroups": [
    {
      "FunctionalGroupHeaderSegment": {
        "GS_01_FunctionalIdentifierCode_ID": "HB",
        "GS_02_ApplicationSendersCode_AN": "SENDER",
        "GS_03_ApplicationReceiversCode_AN": "RECEIVER",
        "GS_04_Date_DT": "20220610",
        "GS_05_Time_TM": "1300",
        "GS_06_GroupControlNumber_N": "1",
        "GS_07_ResponsibleAgencyCode_ID": "X",
        "GS_08_VersionReleaseIndustryIdentifierCode_AN": "005010X279A1"
      },
      "TransactionSets": [
        {
          "TransactionSetHeader": {
            "ST_01_TransactionSetIdentifierCode_ID": "271",
            "ST_02_TransactionSetControlNumber_AN": "4321",
            "ST_03_ImplementationConventionReference_AN": "005010X279A1"
          },
          "BeginningOfHierarchicalTransaction": {
            "BHT_01_HierarchicalStructureCode_ID": "0022",
            "BHT_02_TransactionSetPurposeCode_ID": "11",
            "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"
              },
              "RequestValidation": null,
              "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
                },
                "InformationSourceContactInformation": null,
                "RequestValidation": 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,
                "InformationReceiverRequestValidation": 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": "2",
                  "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": "JOHN",
                  "NM1_05_NameMiddle_AN": null,
                  "NM1_06_NamePrefix_AN": null,
                  "NM1_07_NameSuffix_AN": null,
                  "NM1_08_IdentificationCodeQualifier_ID": "MI",
                  "NM1_09_IdentificationCode_AN": "123456789",
                  "NM1_10_EntityRelationshipCode_ID": null,
                  "NM1_11_EntityIdentifierCode_ID": null,
                  "NM1_12_NameLastOrOrganizationName_AN": null
                },
                "SubscriberAdditionalIdentification": null,
                "SubscriberAddress": {
                  "N3_01_AddressInformation_AN": "15197 BROADWAY AVENUE",
                  "N3_02_AddressInformation_AN": "APT 215"
                },
                "SubscriberCityStateZipCode": {
                  "N4_01_CityName_AN": "KANSAS CITY",
                  "N4_02_StateOrProvinceCode_ID": "MO",
                  "N4_03_PostalCode_ID": "64108",
                  "N4_04_CountryCode_ID": null,
                  "N4_05_LocationQualifier_ID": null,
                  "N4_06_LocationIdentifier_AN": null,
                  "N4_07_CountrySubdivisionCode_ID": null
                },
                "SubscriberRequestValidation": null,
                "ProviderInformation": null,
                "SubscriberDemographicInformation": {
                  "DMG_01_DateTimePeriodFormatQualifier_ID": "D8",
                  "DMG_02_DateTimePeriod_AN": "19630519",
                  "DMG_03_GenderCode_ID": "M",
                  "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
                },
                "SubscriberRelationship": null,
                "SubscriberHealthCareDiagnosisCode": null,
                "SubscriberDate": [
                  {
                    "DTP_01_DateTimeQualifier_ID": "346",
                    "DTP_02_DateTimePeriodFormatQualifier_ID": "D8",
                    "DTP_03_DateTimePeriod_AN": "20060101"
                  }
                ],
                "SubscriberMilitaryPersonnelInformation": null,
                "SubscriberEligibilityOrBenefitInformation_Loop_2110C": [
                  {
                    "SubscriberEligibilityOrBenefitInformation": {
                      "EB_01_EligibiityOrBenefitInformationCode_ID": "1",
                      "EB_02_CoverageLevelCode_ID": null,
                      "EB_03_ServiceTypeCode_ID": [
                        "30"
                      ],
                      "EB_04_InsuranceTypeCode_ID": null,
                      "EB_05_PlanCoverageDescription_AN": "GOLD 123 PLAN",
                      "EB_06_TimePeriodQualifier_ID": null,
                      "EB_07_MonetaryAmount_R": null,
                      "EB_08_PercentageAsDecimal_R": null,
                      "EB_09_QuantityQualifier_ID": null,
                      "EB_10_Quantity_R": null,
                      "EB_11_YesNoConditionOrResponseCode_ID": null,
                      "EB_12_YesNoConditionOrResponseCode_ID": null,
                      "EB_13_CompositeMedicalProcedureIdentifier": null,
                      "EB_14_CompositeDiagnosisCodePointer": null
                    },
                    "HealthCareServicesDelivery": null,
                    "SubscriberAdditionalIdentification": null,
                    "SubscribeEligibilityBenefitDate": null,
                    "SubscriberRequestValidation": null,
                    "MessageText": null,
                    "SubscriberEligibilityOrBenefitAdditionalInformation_Loop_2115C": [
                      {
                        "SubscriberEligibilityOrBenefitAdditionalInformation": null
                      }
                    ],
                    "LoopHeader": null,
                    "SubscriberBenefitRelatedEntityName_Loop_2120C": [
                      {
                        "SubscriberBenefitRelatedEntityName": null,
                        "SubscriberBenefitRelatedEntityAddress": null,
                        "SubscriberBenefitRelatedEntityCityStateZipCode": null,
                        "SubscriberBenefitRelatedEntityContactInformation": null,
                        "SubscriberBenefitRelatedProviderInformation": null
                      }
                    ],
                    "LoopTrailer": null
                  },
                  {
                    "SubscriberEligibilityOrBenefitInformation": {
                      "EB_01_EligibiityOrBenefitInformationCode_ID": "L",
                      "EB_02_CoverageLevelCode_ID": null,
                      "EB_03_ServiceTypeCode_ID": null,
                      "EB_04_InsuranceTypeCode_ID": null,
                      "EB_05_PlanCoverageDescription_AN": null,
                      "EB_06_TimePeriodQualifier_ID": null,
                      "EB_07_MonetaryAmount_R": null,
                      "EB_08_PercentageAsDecimal_R": null,
                      "EB_09_QuantityQualifier_ID": null,
                      "EB_10_Quantity_R": null,
                      "EB_11_YesNoConditionOrResponseCode_ID": null,
                      "EB_12_YesNoConditionOrResponseCode_ID": null,
                      "EB_13_CompositeMedicalProcedureIdentifier": null,
                      "EB_14_CompositeDiagnosisCodePointer": null
                    },
                    "HealthCareServicesDelivery": null,
                    "SubscriberAdditionalIdentification": null,
                    "SubscribeEligibilityBenefitDate": null,
                    "SubscriberRequestValidation": null,
                    "MessageText": null,
                    "SubscriberEligibilityOrBenefitAdditionalInformation_Loop_2115C": [
                      {
                        "SubscriberEligibilityOrBenefitAdditionalInformation": null
                      }
                    ],
                    "LoopHeader": {
                      "LS_01_LoopIdentifierCode_AN": "2120"
                    },
                    "SubscriberBenefitRelatedEntityName_Loop_2120C": [
                      {
                        "SubscriberBenefitRelatedEntityName": {
                          "NM1_01_EntityIdentifierCode_ID": "P3",
                          "NM1_02_EntityTypeQualifier_ID": "1",
                          "NM1_03_NameLastOrOrganizationName_AN": "JONES",
                          "NM1_04_NameFirst_AN": "MARCUS",
                          "NM1_05_NameMiddle_AN": null,
                          "NM1_06_NamePrefix_AN": null,
                          "NM1_07_NameSuffix_AN": null,
                          "NM1_08_IdentificationCodeQualifier_ID": "SV",
                          "NM1_09_IdentificationCode_AN": "0202034",
                          "NM1_10_EntityRelationshipCode_ID": null,
                          "NM1_11_EntityIdentifierCode_ID": null,
                          "NM1_12_NameLastOrOrganizationName_AN": null
                        },
                        "SubscriberBenefitRelatedEntityAddress": null,
                        "SubscriberBenefitRelatedEntityCityStateZipCode": null,
                        "SubscriberBenefitRelatedEntityContactInformation": null,
                        "SubscriberBenefitRelatedProviderInformation": null
                      }
                    ],
                    "LoopTrailer": {
                      "LE_01_LoopIdentifierCode_AN": "2120"
                    }
                  },
                  {
                    "SubscriberEligibilityOrBenefitInformation": {
                      "EB_01_EligibiityOrBenefitInformationCode_ID": "1",
                      "EB_02_CoverageLevelCode_ID": null,
                      "EB_03_ServiceTypeCode_ID": [
                        "1",
                        "33",
                        "35",
                        "47",
                        "86",
                        "88",
                        "98",
                        "AL",
                        "MH",
                        "UC"
                      ],
                      "EB_04_InsuranceTypeCode_ID": null,
                      "EB_05_PlanCoverageDescription_AN": null,
                      "EB_06_TimePeriodQualifier_ID": null,
                      "EB_07_MonetaryAmount_R": null,
                      "EB_08_PercentageAsDecimal_R": null,
                      "EB_09_QuantityQualifier_ID": null,
                      "EB_10_Quantity_R": null,
                      "EB_11_YesNoConditionOrResponseCode_ID": null,
                      "EB_12_YesNoConditionOrResponseCode_ID": null,
                      "EB_13_CompositeMedicalProcedureIdentifier": null,
                      "EB_14_CompositeDiagnosisCodePointer": null
                    },
                    "HealthCareServicesDelivery": null,
                    "SubscriberAdditionalIdentification": null,
                    "SubscribeEligibilityBenefitDate": null,
                    "SubscriberRequestValidation": null,
                    "MessageText": null,
                    "SubscriberEligibilityOrBenefitAdditionalInformation_Loop_2115C": [
                      {
                        "SubscriberEligibilityOrBenefitAdditionalInformation": null
                      }
                    ],
                    "LoopHeader": null,
                    "SubscriberBenefitRelatedEntityName_Loop_2120C": [
                      {
                        "SubscriberBenefitRelatedEntityName": null,
                        "SubscriberBenefitRelatedEntityAddress": null,
                        "SubscriberBenefitRelatedEntityCityStateZipCode": null,
                        "SubscriberBenefitRelatedEntityContactInformation": null,
                        "SubscriberBenefitRelatedProviderInformation": null
                      }
                    ],
                    "LoopTrailer": null
                  },
                  {
                    "SubscriberEligibilityOrBenefitInformation": {
                      "EB_01_EligibiityOrBenefitInformationCode_ID": "B",
                      "EB_02_CoverageLevelCode_ID": null,
                      "EB_03_ServiceTypeCode_ID": [
                        "1",
                        "33",
                        "35",
                        "47",
                        "86",
                        "88",
                        "98",
                        "AL",
                        "MH",
                        "UC"
                      ],
                      "EB_04_InsuranceTypeCode_ID": "HM",
                      "EB_05_PlanCoverageDescription_AN": "GOLD 123 PLAN",
                      "EB_06_TimePeriodQualifier_ID": "27",
                      "EB_07_MonetaryAmount_R": "10",
                      "EB_08_PercentageAsDecimal_R": null,
                      "EB_09_QuantityQualifier_ID": null,
                      "EB_10_Quantity_R": null,
                      "EB_11_YesNoConditionOrResponseCode_ID": null,
                      "EB_12_YesNoConditionOrResponseCode_ID": "Y",
                      "EB_13_CompositeMedicalProcedureIdentifier": null,
                      "EB_14_CompositeDiagnosisCodePointer": null
                    },
                    "HealthCareServicesDelivery": null,
                    "SubscriberAdditionalIdentification": null,
                    "SubscribeEligibilityBenefitDate": null,
                    "SubscriberRequestValidation": null,
                    "MessageText": null,
                    "SubscriberEligibilityOrBenefitAdditionalInformation_Loop_2115C": [
                      {
                        "SubscriberEligibilityOrBenefitAdditionalInformation": null
                      }
                    ],
                    "LoopHeader": null,
                    "SubscriberBenefitRelatedEntityName_Loop_2120C": [
                      {
                        "SubscriberBenefitRelatedEntityName": null,
                        "SubscriberBenefitRelatedEntityAddress": null,
                        "SubscriberBenefitRelatedEntityCityStateZipCode": null,
                        "SubscriberBenefitRelatedEntityContactInformation": null,
                        "SubscriberBenefitRelatedProviderInformation": null
                      }
                    ],
                    "LoopTrailer": null
                  },
                  {
                    "SubscriberEligibilityOrBenefitInformation": {
                      "EB_01_EligibiityOrBenefitInformationCode_ID": "B",
                      "EB_02_CoverageLevelCode_ID": null,
                      "EB_03_ServiceTypeCode_ID": [
                        "1",
                        "33",
                        "35",
                        "47",
                        "86",
                        "88",
                        "98",
                        "AL",
                        "MH",
                        "UC"
                      ],
                      "EB_04_InsuranceTypeCode_ID": "HM",
                      "EB_05_PlanCoverageDescription_AN": "GOLD 123 PLAN",
                      "EB_06_TimePeriodQualifier_ID": "27",
                      "EB_07_MonetaryAmount_R": "30",
                      "EB_08_PercentageAsDecimal_R": null,
                      "EB_09_QuantityQualifier_ID": null,
                      "EB_10_Quantity_R": null,
                      "EB_11_YesNoConditionOrResponseCode_ID": null,
                      "EB_12_YesNoConditionOrResponseCode_ID": "N",
                      "EB_13_CompositeMedicalProcedureIdentifier": null,
                      "EB_14_CompositeDiagnosisCodePointer": null
                    },
                    "HealthCareServicesDelivery": null,
                    "SubscriberAdditionalIdentification": null,
                    "SubscribeEligibilityBenefitDate": null,
                    "SubscriberRequestValidation": null,
                    "MessageText": null,
                    "SubscriberEligibilityOrBenefitAdditionalInformation_Loop_2115C": [
                      {
                        "SubscriberEligibilityOrBenefitAdditionalInformation": null
                      }
                    ],
                    "LoopHeader": null,
                    "SubscriberBenefitRelatedEntityName_Loop_2120C": [
                      {
                        "SubscriberBenefitRelatedEntityName": null,
                        "SubscriberBenefitRelatedEntityAddress": null,
                        "SubscriberBenefitRelatedEntityCityStateZipCode": null,
                        "SubscriberBenefitRelatedEntityContactInformation": null,
                        "SubscriberBenefitRelatedProviderInformation": null
                      }
                    ],
                    "LoopTrailer": null
                  }
                ]
              }
            }
          ],
          "DependentLevel_Loop_2000D": [
            {
              "DependentLevel": null,
              "DependentTraceNumber": null,
              "DependentName_Loop_2100D": {
                "DependentName": null,
                "DependentAdditionalIdentification": null,
                "DependentAddress": null,
                "DependentCityStateZipCode": null,
                "DependentRequestValidation": null,
                "ProviderInformation": null,
                "DependentDemographicInformation": null,
                "DependentRelationship": null,
                "DependentHealthCareDiagnosisCode": null,
                "DependentDate": null,
                "DependentMilitaryPersonnelInformation": null,
                "DependentEligibilityOrBenefitInformation_Loop_2110D": [
                  {
                    "DependentEligibilityOrBenefitInformation": null,
                    "HealthCareServicesDelivery": null,
                    "DependentAdditionalIdentification": null,
                    "DependentEligibilityBenefitDate": null,
                    "DependentRequestValidation": null,
                    "MessageText": null,
                    "DependentEligibilityOrBenefitAdditionalInformation_Loop_2115D": [
                      {
                        "DependentEligibilityOrBenefitAdditionalInformation": null
                      }
                    ],
                    "LoopHeader": null,
                    "DependentBenefitRelatedEntityName_Loop_2120D": [
                      {
                        "DependentBenefitRelatedEntityName": null,
                        "DependentBenefitRelatedEntityAddress": null,
                        "DependentBenefitRelatedEntityCityStateZipCode": null,
                        "DependentBenefitRelatedEntityContactInformation": null,
                        "DependentBenefitRelatedEntityProviderInformation": null
                      }
                    ],
                    "LoopTrailer": null
                  }
                ]
              }
            }
          ],
          "TransactionSetTrailer": {
            "SE_01_NumberOfIncludedSegments_N": "22",
            "SE_02_TransactionSetControlNumber_AN": "4321"
          }
        }
      ],
      "FunctionalGroupTrailerSegment": {
        "GE_01_NumberOfTransactionSetsIncluded_N": "2",
        "GE_02_GroupControlNumber_N": "1"
      }
    }
  ],
  "InterchangeControlTrailerSegment": {
    "IEA_01_NumberOfIncludedFunctionalGroups_N": "1",
    "IEA_02_InterchangeControlNumber_N": "161130044"
  }
}

JSON Request to EDI 271 Response

Transforms JSON into an EDI 271 message.

post https://api-edi.splinxtechnologies.com/v1/edi-transformation/json-to-edi271

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": "SENDER         ",
    "ISA_07_InterchangeIDQualifier_ID": "ZZ",
    "ISA_08_InterchangeReceiverID_AN": "RECEIVER       ",
    "ISA_09_InterchangeDate_DT": "220610",
    "ISA_10_InterchangeTime_TM": "1300",
    "ISA_11_RepetitionSeparator": "^",
    "ISA_12_InterchangeControlVersionNumber_ID": "00501",
    "ISA_13_InterchangeControlNumber_N": "161130044",
    "ISA_14_AcknowledgmentRequest_ID": "0",
    "ISA_15_InterchangeUsageIndicator_ID": "P",
    "ISA_16_ComponentElementSeparator": ":"
  },
  "FunctionalGroups": [
    {
      "FunctionalGroupHeaderSegment": {
        "GS_01_FunctionalIdentifierCode_ID": "HB",
        "GS_02_ApplicationSendersCode_AN": "SENDER",
        "GS_03_ApplicationReceiversCode_AN": "RECEIVER",
        "GS_04_Date_DT": "20220610",
        "GS_05_Time_TM": "1300",
        "GS_06_GroupControlNumber_N": "1",
        "GS_07_ResponsibleAgencyCode_ID": "X",
        "GS_08_VersionReleaseIndustryIdentifierCode_AN": "005010X279A1"
      },
      "TransactionSets": [
        {
          "TransactionSetHeader": {
            "ST_01_TransactionSetIdentifierCode_ID": "271",
            "ST_02_TransactionSetControlNumber_AN": "4321",
            "ST_03_ImplementationConventionReference_AN": "005010X279A1"
          },
          "BeginningOfHierarchicalTransaction": {
            "BHT_01_HierarchicalStructureCode_ID": "0022",
            "BHT_02_TransactionSetPurposeCode_ID": "11",
            "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"
              },
              "RequestValidation": null,
              "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
                },
                "InformationSourceContactInformation": null,
                "RequestValidation": 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,
                "InformationReceiverRequestValidation": 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": "2",
                  "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": "JOHN",
                  "NM1_05_NameMiddle_AN": null,
                  "NM1_06_NamePrefix_AN": null,
                  "NM1_07_NameSuffix_AN": null,
                  "NM1_08_IdentificationCodeQualifier_ID": "MI",
                  "NM1_09_IdentificationCode_AN": "123456789",
                  "NM1_10_EntityRelationshipCode_ID": null,
                  "NM1_11_EntityIdentifierCode_ID": null,
                  "NM1_12_NameLastOrOrganizationName_AN": null
                },
                "SubscriberAdditionalIdentification": null,
                "SubscriberAddress": {
                  "N3_01_AddressInformation_AN": "15197 BROADWAY AVENUE",
                  "N3_02_AddressInformation_AN": "APT 215"
                },
                "SubscriberCityStateZipCode": {
                  "N4_01_CityName_AN": "KANSAS CITY",
                  "N4_02_StateOrProvinceCode_ID": "MO",
                  "N4_03_PostalCode_ID": "64108",
                  "N4_04_CountryCode_ID": null,
                  "N4_05_LocationQualifier_ID": null,
                  "N4_06_LocationIdentifier_AN": null,
                  "N4_07_CountrySubdivisionCode_ID": null
                },
                "SubscriberRequestValidation": null,
                "ProviderInformation": null,
                "SubscriberDemographicInformation": {
                  "DMG_01_DateTimePeriodFormatQualifier_ID": "D8",
                  "DMG_02_DateTimePeriod_AN": "19630519",
                  "DMG_03_GenderCode_ID": "M",
                  "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
                },
                "SubscriberRelationship": null,
                "SubscriberHealthCareDiagnosisCode": null,
                "SubscriberDate": [
                  {
                    "DTP_01_DateTimeQualifier_ID": "346",
                    "DTP_02_DateTimePeriodFormatQualifier_ID": "D8",
                    "DTP_03_DateTimePeriod_AN": "20060101"
                  }
                ],
                "SubscriberMilitaryPersonnelInformation": null,
                "SubscriberEligibilityOrBenefitInformation_Loop_2110C": [
                  {
                    "SubscriberEligibilityOrBenefitInformation": {
                      "EB_01_EligibiityOrBenefitInformationCode_ID": "1",
                      "EB_02_CoverageLevelCode_ID": null,
                      "EB_03_ServiceTypeCode_ID": [
                        "30"
                      ],
                      "EB_04_InsuranceTypeCode_ID": null,
                      "EB_05_PlanCoverageDescription_AN": "GOLD 123 PLAN",
                      "EB_06_TimePeriodQualifier_ID": null,
                      "EB_07_MonetaryAmount_R": null,
                      "EB_08_PercentageAsDecimal_R": null,
                      "EB_09_QuantityQualifier_ID": null,
                      "EB_10_Quantity_R": null,
                      "EB_11_YesNoConditionOrResponseCode_ID": null,
                      "EB_12_YesNoConditionOrResponseCode_ID": null,
                      "EB_13_CompositeMedicalProcedureIdentifier": null,
                      "EB_14_CompositeDiagnosisCodePointer": null
                    },
                    "HealthCareServicesDelivery": null,
                    "SubscriberAdditionalIdentification": null,
                    "SubscribeEligibilityBenefitDate": null,
                    "SubscriberRequestValidation": null,
                    "MessageText": null,
                    "SubscriberEligibilityOrBenefitAdditionalInformation_Loop_2115C": [
                      {
                        "SubscriberEligibilityOrBenefitAdditionalInformation": null
                      }
                    ],
                    "LoopHeader": null,
                    "SubscriberBenefitRelatedEntityName_Loop_2120C": [
                      {
                        "SubscriberBenefitRelatedEntityName": null,
                        "SubscriberBenefitRelatedEntityAddress": null,
                        "SubscriberBenefitRelatedEntityCityStateZipCode": null,
                        "SubscriberBenefitRelatedEntityContactInformation": null,
                        "SubscriberBenefitRelatedProviderInformation": null
                      }
                    ],
                    "LoopTrailer": null
                  },
                  {
                    "SubscriberEligibilityOrBenefitInformation": {
                      "EB_01_EligibiityOrBenefitInformationCode_ID": "L",
                      "EB_02_CoverageLevelCode_ID": null,
                      "EB_03_ServiceTypeCode_ID": null,
                      "EB_04_InsuranceTypeCode_ID": null,
                      "EB_05_PlanCoverageDescription_AN": null,
                      "EB_06_TimePeriodQualifier_ID": null,
                      "EB_07_MonetaryAmount_R": null,
                      "EB_08_PercentageAsDecimal_R": null,
                      "EB_09_QuantityQualifier_ID": null,
                      "EB_10_Quantity_R": null,
                      "EB_11_YesNoConditionOrResponseCode_ID": null,
                      "EB_12_YesNoConditionOrResponseCode_ID": null,
                      "EB_13_CompositeMedicalProcedureIdentifier": null,
                      "EB_14_CompositeDiagnosisCodePointer": null
                    },
                    "HealthCareServicesDelivery": null,
                    "SubscriberAdditionalIdentification": null,
                    "SubscribeEligibilityBenefitDate": null,
                    "SubscriberRequestValidation": null,
                    "MessageText": null,
                    "SubscriberEligibilityOrBenefitAdditionalInformation_Loop_2115C": [
                      {
                        "SubscriberEligibilityOrBenefitAdditionalInformation": null
                      }
                    ],
                    "LoopHeader": {
                      "LS_01_LoopIdentifierCode_AN": "2120"
                    },
                    "SubscriberBenefitRelatedEntityName_Loop_2120C": [
                      {
                        "SubscriberBenefitRelatedEntityName": {
                          "NM1_01_EntityIdentifierCode_ID": "P3",
                          "NM1_02_EntityTypeQualifier_ID": "1",
                          "NM1_03_NameLastOrOrganizationName_AN": "JONES",
                          "NM1_04_NameFirst_AN": "MARCUS",
                          "NM1_05_NameMiddle_AN": null,
                          "NM1_06_NamePrefix_AN": null,
                          "NM1_07_NameSuffix_AN": null,
                          "NM1_08_IdentificationCodeQualifier_ID": "SV",
                          "NM1_09_IdentificationCode_AN": "0202034",
                          "NM1_10_EntityRelationshipCode_ID": null,
                          "NM1_11_EntityIdentifierCode_ID": null,
                          "NM1_12_NameLastOrOrganizationName_AN": null
                        },
                        "SubscriberBenefitRelatedEntityAddress": null,
                        "SubscriberBenefitRelatedEntityCityStateZipCode": null,
                        "SubscriberBenefitRelatedEntityContactInformation": null,
                        "SubscriberBenefitRelatedProviderInformation": null
                      }
                    ],
                    "LoopTrailer": {
                      "LE_01_LoopIdentifierCode_AN": "2120"
                    }
                  },
                  {
                    "SubscriberEligibilityOrBenefitInformation": {
                      "EB_01_EligibiityOrBenefitInformationCode_ID": "1",
                      "EB_02_CoverageLevelCode_ID": null,
                      "EB_03_ServiceTypeCode_ID": [
                        "1",
                        "33",
                        "35",
                        "47",
                        "86",
                        "88",
                        "98",
                        "AL",
                        "MH",
                        "UC"
                      ],
                      "EB_04_InsuranceTypeCode_ID": null,
                      "EB_05_PlanCoverageDescription_AN": null,
                      "EB_06_TimePeriodQualifier_ID": null,
                      "EB_07_MonetaryAmount_R": null,
                      "EB_08_PercentageAsDecimal_R": null,
                      "EB_09_QuantityQualifier_ID": null,
                      "EB_10_Quantity_R": null,
                      "EB_11_YesNoConditionOrResponseCode_ID": null,
                      "EB_12_YesNoConditionOrResponseCode_ID": null,
                      "EB_13_CompositeMedicalProcedureIdentifier": null,
                      "EB_14_CompositeDiagnosisCodePointer": null
                    },
                    "HealthCareServicesDelivery": null,
                    "SubscriberAdditionalIdentification": null,
                    "SubscribeEligibilityBenefitDate": null,
                    "SubscriberRequestValidation": null,
                    "MessageText": null,
                    "SubscriberEligibilityOrBenefitAdditionalInformation_Loop_2115C": [
                      {
                        "SubscriberEligibilityOrBenefitAdditionalInformation": null
                      }
                    ],
                    "LoopHeader": null,
                    "SubscriberBenefitRelatedEntityName_Loop_2120C": [
                      {
                        "SubscriberBenefitRelatedEntityName": null,
                        "SubscriberBenefitRelatedEntityAddress": null,
                        "SubscriberBenefitRelatedEntityCityStateZipCode": null,
                        "SubscriberBenefitRelatedEntityContactInformation": null,
                        "SubscriberBenefitRelatedProviderInformation": null
                      }
                    ],
                    "LoopTrailer": null
                  },
                  {
                    "SubscriberEligibilityOrBenefitInformation": {
                      "EB_01_EligibiityOrBenefitInformationCode_ID": "B",
                      "EB_02_CoverageLevelCode_ID": null,
                      "EB_03_ServiceTypeCode_ID": [
                        "1",
                        "33",
                        "35",
                        "47",
                        "86",
                        "88",
                        "98",
                        "AL",
                        "MH",
                        "UC"
                      ],
                      "EB_04_InsuranceTypeCode_ID": "HM",
                      "EB_05_PlanCoverageDescription_AN": "GOLD 123 PLAN",
                      "EB_06_TimePeriodQualifier_ID": "27",
                      "EB_07_MonetaryAmount_R": "10",
                      "EB_08_PercentageAsDecimal_R": null,
                      "EB_09_QuantityQualifier_ID": null,
                      "EB_10_Quantity_R": null,
                      "EB_11_YesNoConditionOrResponseCode_ID": null,
                      "EB_12_YesNoConditionOrResponseCode_ID": "Y",
                      "EB_13_CompositeMedicalProcedureIdentifier": null,
                      "EB_14_CompositeDiagnosisCodePointer": null
                    },
                    "HealthCareServicesDelivery": null,
                    "SubscriberAdditionalIdentification": null,
                    "SubscribeEligibilityBenefitDate": null,
                    "SubscriberRequestValidation": null,
                    "MessageText": null,
                    "SubscriberEligibilityOrBenefitAdditionalInformation_Loop_2115C": [
                      {
                        "SubscriberEligibilityOrBenefitAdditionalInformation": null
                      }
                    ],
                    "LoopHeader": null,
                    "SubscriberBenefitRelatedEntityName_Loop_2120C": [
                      {
                        "SubscriberBenefitRelatedEntityName": null,
                        "SubscriberBenefitRelatedEntityAddress": null,
                        "SubscriberBenefitRelatedEntityCityStateZipCode": null,
                        "SubscriberBenefitRelatedEntityContactInformation": null,
                        "SubscriberBenefitRelatedProviderInformation": null
                      }
                    ],
                    "LoopTrailer": null
                  },
                  {
                    "SubscriberEligibilityOrBenefitInformation": {
                      "EB_01_EligibiityOrBenefitInformationCode_ID": "B",
                      "EB_02_CoverageLevelCode_ID": null,
                      "EB_03_ServiceTypeCode_ID": [
                        "1",
                        "33",
                        "35",
                        "47",
                        "86",
                        "88",
                        "98",
                        "AL",
                        "MH",
                        "UC"
                      ],
                      "EB_04_InsuranceTypeCode_ID": "HM",
                      "EB_05_PlanCoverageDescription_AN": "GOLD 123 PLAN",
                      "EB_06_TimePeriodQualifier_ID": "27",
                      "EB_07_MonetaryAmount_R": "30",
                      "EB_08_PercentageAsDecimal_R": null,
                      "EB_09_QuantityQualifier_ID": null,
                      "EB_10_Quantity_R": null,
                      "EB_11_YesNoConditionOrResponseCode_ID": null,
                      "EB_12_YesNoConditionOrResponseCode_ID": "N",
                      "EB_13_CompositeMedicalProcedureIdentifier": null,
                      "EB_14_CompositeDiagnosisCodePointer": null
                    },
                    "HealthCareServicesDelivery": null,
                    "SubscriberAdditionalIdentification": null,
                    "SubscribeEligibilityBenefitDate": null,
                    "SubscriberRequestValidation": null,
                    "MessageText": null,
                    "SubscriberEligibilityOrBenefitAdditionalInformation_Loop_2115C": [
                      {
                        "SubscriberEligibilityOrBenefitAdditionalInformation": null
                      }
                    ],
                    "LoopHeader": null,
                    "SubscriberBenefitRelatedEntityName_Loop_2120C": [
                      {
                        "SubscriberBenefitRelatedEntityName": null,
                        "SubscriberBenefitRelatedEntityAddress": null,
                        "SubscriberBenefitRelatedEntityCityStateZipCode": null,
                        "SubscriberBenefitRelatedEntityContactInformation": null,
                        "SubscriberBenefitRelatedProviderInformation": null
                      }
                    ],
                    "LoopTrailer": null
                  }
                ]
              }
            }
          ],
          "DependentLevel_Loop_2000D": [
            {
              "DependentLevel": null,
              "DependentTraceNumber": null,
              "DependentName_Loop_2100D": {
                "DependentName": null,
                "DependentAdditionalIdentification": null,
                "DependentAddress": null,
                "DependentCityStateZipCode": null,
                "DependentRequestValidation": null,
                "ProviderInformation": null,
                "DependentDemographicInformation": null,
                "DependentRelationship": null,
                "DependentHealthCareDiagnosisCode": null,
                "DependentDate": null,
                "DependentMilitaryPersonnelInformation": null,
                "DependentEligibilityOrBenefitInformation_Loop_2110D": [
                  {
                    "DependentEligibilityOrBenefitInformation": null,
                    "HealthCareServicesDelivery": null,
                    "DependentAdditionalIdentification": null,
                    "DependentEligibilityBenefitDate": null,
                    "DependentRequestValidation": null,
                    "MessageText": null,
                    "DependentEligibilityOrBenefitAdditionalInformation_Loop_2115D": [
                      {
                        "DependentEligibilityOrBenefitAdditionalInformation": null
                      }
                    ],
                    "LoopHeader": null,
                    "DependentBenefitRelatedEntityName_Loop_2120D": [
                      {
                        "DependentBenefitRelatedEntityName": null,
                        "DependentBenefitRelatedEntityAddress": null,
                        "DependentBenefitRelatedEntityCityStateZipCode": null,
                        "DependentBenefitRelatedEntityContactInformation": null,
                        "DependentBenefitRelatedEntityProviderInformation": null
                      }
                    ],
                    "LoopTrailer": null
                  }
                ]
              }
            }
          ],
          "TransactionSetTrailer": {
            "SE_01_NumberOfIncludedSegments_N": "22",
            "SE_02_TransactionSetControlNumber_AN": "4321"
          }
        }
      ],
      "FunctionalGroupTrailerSegment": {
        "GE_01_NumberOfTransactionSetsIncluded_N": "2",
        "GE_02_GroupControlNumber_N": "1"
      }
    }
  ],
  "InterchangeControlTrailerSegment": {
    "IEA_01_NumberOfIncludedFunctionalGroups_N": "1",
    "IEA_02_InterchangeControlNumber_N": "161130044"
  }
}

Sample response

EDI 271 Copy

ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *220610*1300*^*00501*161130044*0*P*:~GS*HB*SENDER*RECEIVER*20220610*1300*1*X*005010X279A1~ST*271*4321*005010X279A1~BHT*0022*11*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*2*93175-012547*9877281234~NM1*IL*1*SMITH*JOHN****MI*123456789~N3*15197 BROADWAY AVENUE*APT 215~N4*KANSAS CITY*MO*64108~DMG*D8*19630519*M~DTP*346*D8*20060101~EB*1**30**GOLD 123 PLAN~EB*L~LS*2120~NM1*P3*1*JONES*MARCUS****SV*0202034~LE*2120~EB*1**1^33^35^47^86^88^98^AL^MH^UC~EB*B**1^33^35^47^86^88^98^AL^MH^UC*HM*GOLD 123 PLAN*27*10*****Y~EB*B**1^33^35^47^86^88^98^AL^MH^UC*HM*GOLD 123 PLAN*27*30*****N~SE*22*4321~GE*2*1~IEA*1*161130044~

EligibilityOrBenefitSource fields

Field

Description

EligibilityOrBenefitSourceType

string

EligibilityOrBenefitSourceName

string

MemberProfile fields

Field

Description

FirstName

string<1-35 characters>

LastName

string<1-60 characters>

BirthDate

string<mm/dd/yy>

StreetAddress

string<1-55 characters>

City

string<2-30 characters>

State

string<2 characters>

ZipCode

string<5-15 characters>

InsuredId

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

SSN

string

TraceReferenceId

string<1-50 characters> represents a value that was sent in an EDI 270 request.

ResponseTraceReferenceId

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

EligibilityOrBenefitInformation fields

Field

Description

EligibilityOrBenefitInformationDescription

string represents the description of the eligibility or benefit.

CoverageLevelDescription

string represents the type of coverage for the eligibility or benefit.

InsuranceTypeDescription

string

PlanCoverageDescription

string

EligibilityOrBenefitDates

List<EligibilityOrBenefitDates> represents the dates for the eligibility or benefit. Use class EligibilityOrBenefitDates for reference.

CoveredAmount

string

BenefitPercent

string represents the Co-Insurance patient's portion of responsibility.

TimePeriodQualifier

string represents the time period for the given insurance coverage.

BenefitRelatedEntityNames

List<BenefitRelatedEntityNames> represents any entities that relate to the given eligibility or benefit. Use class BenefitRelatedEntityNames for reference.

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)