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271 Response
Eligibility Response Detail
CIN: QH48702B
Date of Service: Aug. 6, 2026
Submitted: Aug. 10, 2026 6:24 AM
Payload ID: e508b630-a834-449d-ac84-8f076469bf4a
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: ELDERSERVE HEALTH INC MLTCP
Received: Aug. 10, 2026 6:24 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-09-30 | 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 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260810*1024*|*00501*357465612*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1024*465612*X*005010X279A1~ST*270*5612*005010X279A1~BHT*0022*13*202608101024000001*20260810*1024~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*202608101024000001*00000000ND~NM1*IL*1******MI*QH48702B~EQ*30~DTP*291*D8*20260806~SE*13*5612~GE*1*465612~IEA*1*357465612~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260810*0624*^*00501*237412030*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062421*237412030*X*005010X279A1~ST*271*237412030*005010X279A1~BHT*0022*11*202608101024000001*20260810*062421~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*202608101024000001*00000000ND~NM1*IL*1*EDERY*TUNG*H***MI*QH48702B~N3*2 DARTMOUTH ST M33~N4*FOREST HILLS*NY*11375~DMG*D8*19581014*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20251001~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=09~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*R*IND*30~REF*18*9KF4U60XQ04~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*35*237412030~GE*1*237412030~IEA*1*237412030~