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271 Response
Eligibility Response Detail
CIN: TS38530W
Date of Service: Aug. 6, 2026
Submitted: Aug. 9, 2026 3:53 PM
Payload ID: d8a664ae-c4ce-4cea-8a01-09cc6445adac
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 3:53 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 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260809*1953*|*00501*305216005*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1953*216005*X*005010X279A1~ST*270*6005*005010X279A1~BHT*0022*13*202608091953000001*20260809*1953~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*202608091953000001*00000000ND~NM1*IL*1******MI*TS38530W~EQ*30~DTP*291*D8*20260806~SE*13*6005~GE*1*216005~IEA*1*305216005~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260809*1553*^*00501*315015430*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*155331*315015430*X*005010X279A1~ST*271*315015430*005010X279A1~BHT*0022*11*202608091953000001*20260809*155331~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*202608091953000001*00000000ND~NM1*IL*1*PALCHYK*VIKTOR****MI*TS38530W~N3*8695 SANCHO ST~N4*HOLLIS*NY*11423~DMG*D8*19480716*M~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 500~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~SE*28*315015430~GE*1*315015430~IEA*1*315015430~