Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*2011*|*00501*306283923*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*2011*283923*X*005010X279A1~ST*270*3923*005010X279A1~BHT*0022*13*202608092011000001*20260809*2011~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*202608092011000001*00000000ND~NM1*IL*1******MI*WA17816D~EQ*30~DTP*291*D8*20260806~SE*13*3923~GE*1*283923~IEA*1*306283923~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1611*^*00501*318071030*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*161119*318071030*X*005010X279A1~ST*271*318071030*005010X279A1~BHT*0022*11*202608092011000001*20260809*161119~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*202608092011000001*00000000ND~NM1*IL*1*KOROBEYNIKOVA*MARIYA****MI*WA17816D~N3*2662 WEST STREET              3E~N4*BROOKLYN*NY*11223~DMG*D8*19350217*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*5N54W43UY73~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*35*318071030~GE*1*318071030~IEA*1*318071030~