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271 Response
Eligibility Response Detail
CIN: SX51702F
Date of Service: Aug. 6, 2026
Submitted: Aug. 9, 2026 3:46 PM
Payload ID: ad17b23f-d1f4-47d5-a439-7c8df8c38294
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
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| 1 | 88 | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260809*1946*|*00501*304775272*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1946*775272*X*005010X279A1~ST*270*5272*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*SX51702F~EQ*30~DTP*291*D8*20260806~SE*13*5272~GE*1*775272~IEA*1*304775272~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260809*1546*^*00501*311930130*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154611*311930130*X*005010X279A1~ST*271*311930130*005010X279A1~BHT*0022*11*202608091946000001*20260809*154611~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*CHUPKIN*SERGEY****MI*SX51702F~N3*1925 SEAGIRT BLVD 17-O~N4*FAR ROCKAWAY*NY*11691~DMG*D8*19530303*M~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 523~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*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*4JQ2YF9PT95~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*41*311930130~GE*1*311930130~IEA*1*311930130~