Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1948*|*00501*304881643*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1948*881643*X*005010X279A1~ST*270*1643*005010X279A1~BHT*0022*13*202608091948000001*20260809*1948~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*202608091948000001*00000000ND~NM1*IL*1******MI*UD85198M~EQ*30~DTP*291*D8*20260806~SE*13*1643~GE*1*881643~IEA*1*304881643~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1547*^*00501*311993730*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154757*311993730*X*005010X279A1~ST*271*311993730*005010X279A1~BHT*0022*11*202608091948000001*20260809*154757~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*202608091948000001*00000000ND~NM1*IL*1*GITMAN*MIKHAIL****MI*UD85198M~N3*17 WILLETT ST                 4C~N4*NEW YORK*NY*10002~DMG*D8*19491019*M~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20251101~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~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*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*6MX5MP2YY65~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*41*311993730~GE*1*311993730~IEA*1*311993730~