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271 Response
Eligibility Response Detail
CIN: VH07194W
Date of Service: Aug. 6, 2026
Submitted: Aug. 9, 2026 3:49 PM
Payload ID: 2418cc97-88c2-4aa2-9c13-818b6a1fa880
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: SOUTHWEST BROOKLYN HEALTH HOME LLC
Received: Aug. 9, 2026 3:49 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-07-31 | 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 | — | — | — | |
| W | CQ | — | — | — | |
| W | CQ | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260809*1949*|*00501*304976488*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1949*976488*X*005010X279A1~ST*270*6488*005010X279A1~BHT*0022*13*202608091949000001*20260809*1949~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*202608091949000001*00000000ND~NM1*IL*1******MI*VH07194W~EQ*30~DTP*291*D8*20260806~SE*13*6488~GE*1*976488~IEA*1*304976488~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260809*1549*^*00501*312059830*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154932*312059830*X*005010X279A1~ST*271*312059830*005010X279A1~BHT*0022*11*202608091949000001*20260809*154932~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*202608091949000001*00000000ND~NM1*IL*1*KARNYSHEVA*IRINA****MI*VH07194W~N3*80 AVENUE P B4~N4*BROOKLYN*NY*11204~DMG*D8*19550113*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=07~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*W*IND*CQ~LS*2120~NM1*Y2*2*INTERBOROUGH DEV/CONSULT CTRS*****XX*1588611842~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*SOUTHWEST BROOKLYN HEALTH HOME LLC*****XX*1023354933~LE*2120~EB*R*IND*30~REF*18*9RV6TK9CX73~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*46*312059830~GE*1*312059830~IEA*1*312059830~