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271 Response
Eligibility Response Detail
CIN: ZJ80806N
Date of Service: Aug. 6, 2026
Submitted: Aug. 9, 2026 3:44 PM
Payload ID: 245a3a50-51f1-4afc-93d5-0720c85094ec
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: Community Coverage w/CBLTC
MCO: —
Received: Aug. 9, 2026 3:44 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-06-30 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| 1 | 30 | Community Coverage w/CBLTC | — | — | |
| B | 30 | — | — | — | |
| 1 | 1 | — | — | — | |
| 1 | 4 | — | — | — | |
| 1 | 5 | — | — | — | |
| 1 | 33 | — | — | — | |
| 1 | 35 | — | — | — | |
| 1 | 47 | — | — | — | |
| 1 | 48 | — | — | — | |
| 1 | 50 | — | — | — | |
| 1 | 86 | — | — | — | |
| 1 | 88 | — | — | — | |
| 1 | 98 | — | — | — | |
| 1 | AG | — | — | — | |
| 1 | AL | — | — | — | |
| 1 | MH | — | — | — | |
| 1 | UC | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260809*1944*|*00501*304670159*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1944*670159*X*005010X279A1~ST*270*0159*005010X279A1~BHT*0022*13*202608091944000001*20260809*1944~HL*1**20*1~NM1*PR*2*NYSDOH*****PI*EMEDNY~HL*2*1*21*1~NM1*1P*2*MEDICAID PLANNING GROUP CORP*****SV*08046628~PRV*PE*PXC*251B00000X~HL*3*2*22*0~TRN*1*202608091944000001*00000000ND~NM1*IL*1******MI*ZJ80806N~EQ*30~DTP*291*D8*20260806~SE*13*0159~GE*1*670159~IEA*1*304670159~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260809*1544*^*00501*311872930*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154425*311872930*X*005010X279A1~ST*271*311872930*005010X279A1~BHT*0022*11*202608091944000001*20260809*154425~HL*1**20*1~NM1*PR*2*NYSDOH*****FI*141797357~PER*IC*EMEDNY PROVIDER SERVICES*TE*8003439000*UR*www.emedny.org~HL*2*1*21*1~NM1*1P*2*MEDICAID PLANNING GROUP CORP*****SV*08046628~HL*3*2*22*0~TRN*2*202608091944000001*00000000ND~NM1*IL*1*ARCHUTOWSKI*BOGDAN****MI*ZJ80806N~N3*53 INDIA STREET APT 4~N4*BROOKLYN*NY*11222~DMG*D8*19591205*M~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260701~EB*1*IND*30**Community Coverage w/CBLTC~MSG*CNTY CD=66 508~MSG*RECERT MONTH=06~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*33~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AG~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~EB*R*IND*30~REF*6P*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*8FD1D92XV27~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*49*311872930~GE*1*311872930~IEA*1*311872930~