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271 Response
Eligibility Response Detail
CIN: PW66773P
Date of Service: Aug. 6, 2026
Submitted: Aug. 9, 2026 3:46 PM
Payload ID: 2f70235a-aa8a-4652-be4b-36f19fa0486b
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: ANTHEM HP LLC PARTIAL MLTC
Received: Aug. 9, 2026 3:46 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-10-31 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| 1 | 88 | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260809*1946*|*00501*304761524*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1946*761524*X*005010X279A1~ST*270*1524*005010X279A1~BHT*0022*13*202608091946000001*20260809*1946~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*202608091946000001*00000000ND~NM1*IL*1******MI*PW66773P~EQ*30~DTP*291*D8*20260806~SE*13*1524~GE*1*761524~IEA*1*304761524~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260809*1545*^*00501*311923230*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154557*311923230*X*005010X279A1~ST*271*311923230*005010X279A1~BHT*0022*11*202608091946000001*20260809*154557~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*202608091946000001*00000000ND~NM1*IL*1*CASTROCHICA*ANA*C***MI*PW66773P~N3*3750 81ST ST 3D~N4*JACKSON HEIGHTS*NY*11372~DMG*D8*19590220*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260201~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*ANTHEM HP LLC PARTIAL MLTC*****PI*KX~N3*ONE PENN PLZ FL 35~N4*NEW YORK*NY*101190000~PER*IC*PROVIDER SERVICES*TE*2125635570~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*ETRBJ3386148~REF*6P*720902MM1A~LS*2120~NM1*P4*2*ANTHEM BC/BS (EMPIRE)*****PI*12~N3*PO BOX 1407 CHURCH ST STATION*ATTN CLAIMS DEPT~N4*NEW YORK*NY*100081407~PER*IC*PROVIDER SERVICES*TE*8005235978~LE*2120~EB*R*IND*30~REF*18*00338614801~REF*6P*CT132BJ21~LS*2120~NM1*P4*2*OPTUM RX*****PI*ORX~N3*PO BOX 8082~N4*WAUSAU*WI*544028082~PER*IC*PROVIDER SERVICES*TE*8002071561~LE*2120~EB*R*IND*30~REF*18*3GA9W91XM18~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*52*311923230~GE*1*311923230~IEA*1*311923230~