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Key rules for eligibility request and response message

Updated on April 23, 2021

This table lists the key rules used in the processing of the X12 270/271 messages.

Pega Foundation for Healthcare
Rule nameRule typeFunction
Class: PegaHC-EDI-Work-EligibilityRequest
ProcessX12N270ActivityMain activity to launch 270 message processing
Process270TransactionCollectionMain collection rule for processing 270 message
ParseTransactionCollectionParses 270 message and prepares 271 response
ValidateTransactionCollectionControls validation rules for various loops
ValidateInformation SourceCollectionControls validation of Information Source level



CollectionControls validation of Information Receiver level
ValidateSubscriberCollectionControls validation of Subscriber level
ProcessEligibility RequestCollectionControls mapping to work object and processing of benefit request
SendResponseCollectionControls 277 message generation and distribution
ParseMessageActivityParses 270 message
PrepareResponseActivityPrepares 271 message shell
CheckLimitActivityValidates the number of requests in a transaction
CheckProviderOnFileActivityLooks up Provider based on ID submitted on 270
CheckSubscriberOnFileActivityLooks up Subscriber based on ID submitted on 270
MapMessageToWork itemActivityMaps 270 message to work object
ProcessEligibilityActivityInitiates specific benefit request processing
Generate271ActivityGenerates 271 message
SendMessageActivityPlaceholder for 271 message distribution
ReviewX12ActivityProvides side by side comparison of 270-271
  • Previous topic Healthcare eligibility request message processing
  • Next topic Healthcare claim status request message processing

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