Skip to main content

         This documentation site is for previous versions. Visit our new documentation site for current releases.      

EDI Eligibility Request management

Updated on April 12, 2021
Pega Foundation for Healthcare Product Overview

Pega Foundation for Healthcare provides a reference implementation to manage X12 5010 EDI straight-through processing for X12 270 and 271 message transactions – Healthcare Eligibility Request & Response. This capability includes the ability to intake the EDI X12 270 eligibility request message, parse the message according to the EDI transaction implementation guide, create a case, process the eligibility request (leveraging the sample plan benefit eligibility information provided in the sample data), and return an appropriate X12 271 eligibility response message. The functionality can be extended based on your business rules and with appropriate integration with your membership eligibility system.

Have a question? Get answers now.

Visit the Support Center to ask questions, engage in discussions, share ideas, and help others.

Did you find this content helpful?

Want to help us improve this content?

We'd prefer it if you saw us at our best. is not optimized for Internet Explorer. For the optimal experience, please use:

Close Deprecation Notice
Contact us