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271 Response
Eligibility Response Detail
CIN: QC53185N
Date of Service: Aug. 6, 2026
Submitted: Aug. 9, 2026 3:46 PM
Payload ID: 97d5ab9b-7fa6-4c04-b67b-f540829b8a66
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: ELDERSERVE HEALTH INC MLTCP
Received: Aug. 9, 2026 3:46 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-09-30 | 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 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260809*1946*|*00501*304783280*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1946*783280*X*005010X279A1~ST*270*3280*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*QC53185N~EQ*30~DTP*291*D8*20260806~SE*13*3280~GE*1*783280~IEA*1*304783280~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260809*1546*^*00501*311933330*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154619*311933330*X*005010X279A1~ST*271*311933330*005010X279A1~BHT*0022*11*202608091946000001*20260809*154619~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*CZAJKO*HENRYKA****MI*QC53185N~N3*67 MANHATTAN AVENUE 15J~N4*BROOKLYN*NY*11206~DMG*D8*19521023*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20251201~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=09~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*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*8UP4TK8DX08~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*311933330~GE*1*311933330~IEA*1*311933330~