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271 Response
Eligibility Response Detail
CIN: NQ61436U
Date of Service: Aug. 6, 2026
Submitted: Aug. 9, 2026 3:56 PM
Payload ID: 3d3b5046-a88e-4c8d-a469-baf6b775a844
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: ANTHEM HP LLC PARTIAL MLTC
Received: Aug. 9, 2026 3:56 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-12-31 | 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 | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260809*1956*|*00501*305417974*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1956*417974*X*005010X279A1~ST*270*7974*005010X279A1~BHT*0022*13*202608091956000001*20260809*1956~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*202608091956000001*00000000ND~NM1*IL*1******MI*NQ61436U~EQ*30~DTP*291*D8*20260806~SE*13*7974~GE*1*417974~IEA*1*305417974~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260809*1556*^*00501*315152430*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*155653*315152430*X*005010X279A1~ST*271*315152430*005010X279A1~BHT*0022*11*202608091956000001*20260809*155653~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*202608091956000001*00000000ND~NM1*IL*1*SZYCHOWSKA*DANUTA*J***MI*NQ61436U~N3*216 MALLORY AVENUE PH~N4*STATEN ISLAND*NY*10305~DMG*D8*19490814*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20251001~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=12~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*H5599~LS*2120~NM1*P4*2*WELLCARE FIDELIS DUAL ACCESS*****PI*H5599~N3*25-01 JACKSON AVE~N4*LONG ISLAND CITY*NY*11101~PER*IC*PROVIDER SERVICES*TE*8883433547~LE*2120~EB*R*IND*30~REF*18*8AT3JG5XM11~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*315152430~GE*1*315152430~IEA*1*315152430~