Eligibility Management

Real-time eligibility lookup and 270/271 transaction management

Eligibility Lookup

Member ID

— or —

Full Name

Date of Birth

— or —

Last 4 SSN

Eligibility History

Date	Result	Source
Apr 02 09:14	Eligible	EDI 270
Mar 28 14:32	Eligible	Portal
Mar 15 11:05	Eligible	EDI 270
Feb 01 08:47	Ineligible	Manual
Jan 15 16:20	Eligible	EDI 270

MS

Maria Santos

● ELIGIBLE

Member ID: MBR-00421

DOB: Mar 14, 1958

Plan: HMO Premier

Coverage Details

Effective DateJan 1, 2026

Term DateDec 31, 2026

PCP Copay$10

Specialist Copay$30

ER Copay$150

Urgent Care$50

Cost Sharing

Deductible (Ind)$500 / $0 met

Deductible (Fam)$1,000 / $0 met

Coinsurance20% after deductible

OOP Max (Ind)$3,500 / $0 met

Formulary TierTier 2 (Preferred)

Medicare Part DActive

270/271 Transaction Viewer

Raw EDI transaction — Apr 2, 2026 09:14 AM

*--- Eligibility Inquiry (ASC X12 270) ---*

ISA*00* *00* *ZZ*EKLOTHO *ZZ*BCBSCA *260402*0914*^*00501*000000001*0*P*:

GS*HS*EKLOTHO*BCBSCA*20260402*0914*1*X*005010X279A1

ST*270*0001*005010X279A1

BHT*0022*13*ID-MBR00421*20260402*0914

HL*1**20*1 * Information Source

NM1*PR*2*EKLOTHO HEALTH PLAN*****PI*EKLOTHO001

HL*2*1*21*1 * Information Receiver

NM1*1P*2*VALLEY MEDICAL GROUP*****XX*1234567890

HL*3*2*22*0 * Subscriber

TRN*1*TRN20260402001*9EKLOTHO

NM1*IL*1*SANTOS*MARIA****MI*MBR00421

DMG*D8*19580314*F

DTP*291*D8*20260402

EQ*30 * Health Benefit Plan Coverage

AI Assistant

Three lookup methods are available. Use whichever data you have:

Member ID — fastest method; use the format MBR-XXXXX
Name + DOB — use when you have demographic data only
Last 4 SSN — available for Medicaid crossover members

Click Verify Now to submit a real-time 270 transaction.

Effective / Term Date — the period of active coverage
Copays — member out-of-pocket at time of service
Deductible Met — amount already applied toward annual deductible
OOP Max — maximum member financial liability for the plan year
Formulary Tier — prescription drug benefit level

The 270 (Eligibility Inquiry) and 271 (Eligibility Response) are ANSI X12 EDI transactions. The viewer shows the raw transaction that was submitted and received.

Color-coded segments for readability
Switch between Request (270) and Response (271) views
Useful for debugging payer rejection errors

Use Batch Verify to upload a CSV of member IDs and run eligibility checks in bulk. Results are available within 15 minutes and can be exported. Ideal for monthly eligibility sweeps before claim submission.

The history panel shows all previous eligibility checks for the currently displayed member, including the verification source. Ineligible results are flagged red — review these before claim submission.