Import ›
271 Response
Eligibility Response Detail
CIN: WJ63190G
Date of Service: Aug. 6, 2026
Submitted: Aug. 9, 2026 3:49 PM
Payload ID: 86f93423-d6a4-47aa-8b3c-6d8aa7575e8c
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: MA Eligible
MCO: —
Received: Aug. 9, 2026 3:49 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Code 60 | 60 | 60 | MSG | MSG01 | Code 60 found in MSG segment |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| 1 | 30 | MA Eligible | — | — | |
| B | 30 | — | — | — | |
| 1 | 1 | — | — | — | |
| 1 | 4 | — | — | — | |
| 1 | 5 | — | — | — | |
| 1 | 33 | — | — | — | |
| 1 | 35 | — | — | — | |
| 1 | 47 | — | — | — | |
| 1 | 48 | — | — | — | |
| 1 | 50 | — | — | — | |
| 1 | 86 | — | — | — | |
| 1 | 88 | — | — | — | |
| 1 | 98 | — | — | — | |
| 1 | AG | — | — | — | |
| 1 | AL | — | — | — | |
| 1 | MH | — | — | — | |
| 1 | UC | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260809*1949*|*00501*304988499*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1949*988499*X*005010X279A1~ST*270*8499*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*WJ63190G~EQ*30~DTP*291*D8*20260806~SE*13*8499~GE*1*988499~IEA*1*304988499~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260809*1549*^*00501*312066930*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154944*312066930*X*005010X279A1~ST*271*312066930*005010X279A1~BHT*0022*11*202608091949000001*20260809*154944~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*KHAVKINA*FLORA****MI*WJ63190G~N3*7920 19TH AVENUE 4F~N4*BROOKLYN*NY*11214~DMG*D8*19350621*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*1*IND*30**MA Eligible~MSG*CF~MSG*PD~MSG*60~MSG*CNTY CD=66 523~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*33~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AG~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~EB*R*IND*30~REF*18*00000009945~REF*6P*ICA001~LS*2120~NM1*P4*2*DAVIS VISION*****PI*90~N3*PO BOX 1501~N4*LATHAM*NY*121108001~PER*IC*PROVIDER SERVICES*TE*8009995431~LE*2120~EB*R*IND*30~REF*18*7K53GP1XA03~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*52*312066930~GE*1*312066930~IEA*1*312066930~