Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1026*|*00501*357588767*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1026*588767*X*005010X279A1~ST*270*8767*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*XQ69205K~EQ*30~DTP*291*D8*20260806~SE*13*8767~GE*1*588767~IEA*1*357588767~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0626*^*00501*237606430*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062624*237606430*X*005010X279A1~ST*271*237606430*005010X279A1~BHT*0022*11*202608101026000001*20260810*062624~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*HUNTE*ALVIN*N***MI*XQ69205K~N3*375 BLAKE AVE                 6G~N4*BROOKLYN*NY*11212~DMG*D8*19740928*M~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*VILLAGE SENIOR SVC CORP PARTIAL LTC*****PI*VL~N3*112 CHARLES ST FL 2~N4*NEW YORK*NY*100142653~PER*IC*PROVIDER SERVICES*TE*8557692500~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*W*IND*CQ~LS*2120~NM1*Y2*2*INSTITUTE FOR COMMUNITY LIVING*****XX*1164549812~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*COORDINATED BEHAVIORAL CARE INC*****XX*1730451071~LE*2120~EB*R*IND*30~REF*6P*H0423~LS*2120~NM1*P4*2*METROPLUS HEALTH PLAN, INC.*****PI*H0423~N3*160 WATER STREET~N4*NEW YORK*NY*10038~PER*IC*PROVIDER SERVICES*TE*8669860356~LE*2120~EB*R*IND*30~REF*18*3W58M65RK52~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*52*237606430~GE*1*237606430~IEA*1*237606430~