Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1945*|*00501*304749478*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1945*749478*X*005010X279A1~ST*270*9478*005010X279A1~BHT*0022*13*202608091945000001*20260809*1945~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*202608091945000001*00000000ND~NM1*IL*1******MI*YF60579U~EQ*30~DTP*291*D8*20260806~SE*13*9478~GE*1*749478~IEA*1*304749478~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1545*^*00501*311917630*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154545*311917630*X*005010X279A1~ST*271*311917630*005010X279A1~BHT*0022*11*202608091945000001*20260809*154545~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*202608091945000001*00000000ND~NM1*IL*1*BURLAK*HANNA****MI*YF60579U~N3*1102 BENNER AVE               3B~N4*BROOKLYN*NY*11235~DMG*D8*19570102*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20251201~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*ELDERSERVE HEALTH INC MLTCP*****PI*EH~N3*80 W 225TH ST FL 3~N4*BRONX*NY*104637002~PER*IC*PROVIDER SERVICES*TE*8003703600~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H3312~LS*2120~NM1*P4*2*AETNA MEDICARE*****PI*H3312~N3*151 FARMINGTON AVENUE~N4*HARTFORD*CT*06156~PER*IC*PROVIDER SERVICES*TE*8002825366~LE*2120~EB*R*IND*30~REF*18*5NN9NQ3EQ41~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*311917630~GE*1*311917630~IEA*1*311917630~