Key rules for eligibility request and response message
This table lists the key rules used in the processing of the X12 270/271 messages.
Pega Foundation for Healthcare
| Rule name | Rule type | Function |
| Class: PegaHC-EDI-Work-EligibilityRequest | ||
| ProcessX12N270 | Activity | Main activity to launch 270 message processing |
| Process270Transaction | Collection | Main collection rule for processing 270 message |
| ParseTransaction | Collection | Parses 270 message and prepares 271 response |
| ValidateTransaction | Collection | Controls validation rules for various loops |
| ValidateInformation Source | Collection | Controls validation of Information Source level |
ValidateInformation Receiver | Collection | Controls validation of Information Receiver level |
| ValidateSubscriber | Collection | Controls validation of Subscriber level |
| ProcessEligibility Request | Collection | Controls mapping to work object and processing of benefit request |
| SendResponse | Collection | Controls 277 message generation and distribution |
| ParseMessage | Activity | Parses 270 message |
| PrepareResponse | Activity | Prepares 271 message shell |
| CheckLimit | Activity | Validates the number of requests in a transaction |
| CheckProviderOnFile | Activity | Looks up Provider based on ID submitted on 270 |
| CheckSubscriberOnFile | Activity | Looks up Subscriber based on ID submitted on 270 |
| MapMessageToWork item | Activity | Maps 270 message to work object |
| ProcessEligibility | Activity | Initiates specific benefit request processing |
| Generate271 | Activity | Generates 271 message |
| SendMessage | Activity | Placeholder for 271 message distribution |
| ReviewX12 | Activity | Provides side by side comparison of 270-271 |
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