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271 Response
Eligibility Response Detail
CIN: RN25674E
Date of Service: Aug. 6, 2026
Submitted: Aug. 10, 2026 6:26 AM
Payload ID: 532afe4d-894e-471e-938a-c8ba4455efea
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 6:26 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-08-31 | 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 *260810*1026*|*00501*357585759*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1026*585759*X*005010X279A1~ST*270*5759*005010X279A1~BHT*0022*13*202608101026000001*20260810*1026~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*202608101026000001*00000000ND~NM1*IL*1******MI*RN25674E~EQ*30~DTP*291*D8*20260806~SE*13*5759~GE*1*585759~IEA*1*357585759~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260810*0626*^*00501*237603430*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062621*237603430*X*005010X279A1~ST*271*237603430*005010X279A1~BHT*0022*11*202608101026000001*20260810*062621~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*202608101026000001*00000000ND~NM1*IL*1*HRYTSYSHYN*MARIA****MI*RN25674E~N3*2121 SHORE PKWY 7F~N4*BROOKLYN*NY*11214~DMG*D8*19480802*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20251001~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 525~MSG*RECERT MONTH=08~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*6P*H3312~LS*2120~NM1*P4*2*AETNA MEDICARE*****PI*H3312~N3*151 FARMINGTON AVENUE~N4*HARTFORD*CT*06156~PER*IC*PROVIDER SERVICES*TE*8002825366~LE*2120~EB*R*IND*30~REF*18*3J24Q08TJ08~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*237603430~GE*1*237603430~IEA*1*237603430~