CSV to 270 Generation

Need to check patient eligibility but don't have an EDI-capable billing system? EDI Paisan lets you generate valid 270 (Eligibility Inquiry) files from a simple CSV spreadsheet.

Upload your patient data → Preview the generated 270 → Download and submit to your clearinghouse.

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Who Is This For?

This feature is designed for:

• Small practices without full practice management software
• Billers who need to check eligibility for multiple patients
• Anyone who has patient data in a spreadsheet and needs to verify coverage

You don't need to understand X12 syntax. Just fill in the CSV template and let EDI Paisan handle the rest.

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How It Works

Your CSV → EDI Paisan → Valid 270 File → Clearinghouse → Payer

1. Prepare your CSV with patient and provider information
2. Upload to EDI Paisan
3. Preview the generated 270 and review any validation warnings
4. Download the file (Pro tier required)
5. Submit to your clearinghouse for eligibility responses

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CSV Format

Your CSV must include specific columns. Here's the required format:

Required Columns

Column	Description	Example
subscriber_last_name	Subscriber's last name	Smith
subscriber_first_name	Subscriber's first name	John
subscriber_member_id	Insurance member ID	MEM123456789
subscriber_dob	Date of birth (MM/DD/YYYY or YYYY-MM-DD)	03/15/1985
subscriber_gender	Gender (M/F)	M
payer_id	Payer/Insurance ID	BCBS01
payer_name	Payer name	Blue Cross Blue Shield
provider_npi	Your NPI number	1234567890
provider_name	Your practice name	ABC Medical Group
service_date	Date of service (MM/DD/YYYY or YYYY-MM-DD)	01/15/2024

Optional Columns

Column	Description	Example
dependent_last_name	Dependent's last name (if checking dependent)	Smith
dependent_first_name	Dependent's first name	Jane
dependent_dob	Dependent's date of birth	05/20/2010
dependent_gender	Dependent's gender	F
dependent_relationship	Relationship to subscriber	19 (child)
service_type	Service type code (default: 30 = all)	30
trace_number	Your tracking reference	INQ-2024-001

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Example CSV

Basic Example (Subscribers Only)

subscriber_last_name,subscriber_first_name,subscriber_member_id,subscriber_dob,subscriber_gender,payer_id,payer_name,provider_npi,provider_name,service_date
Smith,John,MEM123456,03/15/1985,M,BCBS01,Blue Cross Blue Shield,1234567890,ABC Medical Group,01/15/2024
Johnson,Mary,MEM789012,07/22/1990,F,AETNA01,Aetna,1234567890,ABC Medical Group,01/15/2024
Williams,Robert,MEM345678,11/08/1978,M,UHC01,United Healthcare,1234567890,ABC Medical Group,01/15/2024

With Dependents

subscriber_last_name,subscriber_first_name,subscriber_member_id,subscriber_dob,subscriber_gender,dependent_last_name,dependent_first_name,dependent_dob,dependent_gender,dependent_relationship,payer_id,payer_name,provider_npi,provider_name,service_date
Smith,John,MEM123456,03/15/1985,M,Smith,Jane,05/20/2010,F,19,BCBS01,Blue Cross Blue Shield,1234567890,ABC Medical Group,01/15/2024

With Service Types

subscriber_last_name,subscriber_first_name,subscriber_member_id,subscriber_dob,subscriber_gender,payer_id,payer_name,provider_npi,provider_name,service_date,service_type
Smith,John,MEM123456,03/15/1985,M,BCBS01,Blue Cross Blue Shield,1234567890,ABC Medical Group,01/15/2024,30
Smith,John,MEM123456,03/15/1985,M,BCBS01,Blue Cross Blue Shield,1234567890,ABC Medical Group,01/15/2024,35

TIP

To check multiple service types for the same patient, include multiple rows with different service_type values. EDI Paisan will combine them into a single inquiry.

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Service Type Codes

The service_type column controls what benefit information you're requesting:

Code	Description
30	Health Benefit Plan Coverage (all benefits) — recommended default
1	Medical Care
33	Chiropractic
35	Dental Care
47	Hospital
48	Hospital - Inpatient
50	Hospital - Outpatient
51	Hospital - Emergency Accident
52	Hospital - Emergency Medical
86	Emergency Services
88	Pharmacy
98	Professional (Physician) Visit - Office

If omitted, EDI Paisan defaults to 30 (all benefits).

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Relationship Codes

For dependent inquiries, use these dependent_relationship codes:

Code	Relationship
01	Spouse
19	Child
20	Employee
21	Unknown
39	Organ Donor
40	Cadaver Donor
53	Life Partner
G8	Other Relationship

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Validation & Preview

After uploading your CSV, EDI Paisan:

1. Validates your data for required fields and formatting
2. Previews the generated 270 in the file viewer
3. Shows warnings for any issues that might cause rejections

Common Validation Warnings

Warning	Meaning	Fix
Missing NPI	Provider NPI is required	Add valid 10-digit NPI
Invalid date format	Date couldn't be parsed	Use MM/DD/YYYY or YYYY-MM-DD
Missing member ID	Subscriber member ID required	Add insurance member ID
Unknown payer	Payer ID not recognized	Verify payer ID with clearinghouse

:::note Warnings don't prevent generation, but the resulting 270 may be rejected by payers. :::

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Free vs Pro

Feature	Free	Pro
Upload CSV	✅	✅
Preview generated 270	✅	✅
View validation results	✅	✅
Download 270 file	❌	✅
Batch processing (multiple files)	❌	✅

Free tier lets you see exactly what your 270 will look like before committing to Pro. You can verify your CSV format and data are correct.

Pro tier unlocks the download — the file you can actually submit to your clearinghouse.

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Step-by-Step Guide

1. Prepare Your CSV

• Use the column headers exactly as shown above
• Ensure dates are formatted consistently (MM/DD/YYYY recommended)
• Double-check member IDs against insurance cards
• Use your valid NPI number

2. Upload to EDI Paisan

1. Navigate to Tools → CSV to 270 (or equivalent)
2. Click Upload CSV or drag and drop your file
3. Wait for processing

3. Review the Preview

• Check that patient names and IDs are correct
• Verify the payer information
• Review any validation warnings
• Use the 270 viewer to inspect the generated structure

4. Download (Pro)

If everything looks correct:

1. Click Download 270
2. Save the .edi or .270 file
3. Submit to your clearinghouse

5. Wait for 271 Responses

Your clearinghouse will return 271 (Eligibility Response) files — one response per inquiry. Upload those to EDI Paisan to view the coverage details.

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Troubleshooting

"Invalid CSV format"

Cause: Missing required columns or incorrect headers.

Fix: Ensure your CSV includes all required columns with exact header names (case-sensitive).

"Date parsing failed"

Cause: Dates aren't in a recognized format.

Fix: Use MM/DD/YYYY (e.g., 01/15/2024) or YYYY-MM-DD (e.g., 2024-01-15).

"NPI validation failed"

Cause: NPI is not 10 digits or fails checksum validation.

Fix: Verify your NPI at NPPES NPI Registry.

"Member ID not found" (from payer)

Cause: The member ID doesn't match the payer's records.

Fix: Verify the member ID from the patient's insurance card. Check for typos or missing digits.

"Payer not recognized" (from clearinghouse)

Cause: The payer ID isn't valid for your clearinghouse.

Fix: Contact your clearinghouse for the correct payer ID. Different clearinghouses may use different payer identifiers.

Blank or empty responses

Cause: Payer couldn't process the inquiry.

Fix: Check for AAA rejection segments in the 271. Common reasons:

• Invalid date of birth
• Member not found
• Service date outside coverage period

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Best Practices

Before Uploading

• ✅ Verify member IDs against insurance cards
• ✅ Confirm your NPI is active and valid
• ✅ Use consistent date formats
• ✅ Include trace numbers for easy tracking

After Downloading

• ✅ Submit promptly — eligibility can change
• ✅ Keep copies of your 270s for records
• ✅ Match 271 responses using trace numbers

General Tips

• Batch similar requests — Group patients by payer for easier tracking
• Check before appointments — Run eligibility 1-2 days before scheduled visits
• Re-verify for procedures — Coverage can change; always verify before high-cost procedures

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Related Documentation

• 270 Eligibility Inquiry Reference — Technical details of 270 files
• 271 Eligibility Response Reference — Understanding responses
• Eligibility Summaries — Reading eligibility results
• Service Type Codes — Complete list of service codes