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271 Response
Eligibility Response Detail
CIN: SD13155S
Date of Service: Aug. 6, 2026
Submitted: Aug. 10, 2026 6:29 AM
Payload ID: 6165cab5-0e3b-4234-8848-3b0cab39202f
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. 10, 2026 6:29 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| S1 | S1 | S1 | MSG | MSG01 | S1 exemption code found in MSG segment |
| Recertification | RECERT | 2027-04-30 | 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 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260810*1029*|*00501*357756935*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1029*756935*X*005010X279A1~ST*270*6935*005010X279A1~BHT*0022*13*202608101029000001*20260810*1029~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*202608101029000001*00000000ND~NM1*IL*1******MI*SD13155S~EQ*30~DTP*291*D8*20260806~SE*13*6935~GE*1*756935~IEA*1*357756935~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260810*0629*^*00501*237838130*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062912*237838130*X*005010X279A1~ST*271*237838130*005010X279A1~BHT*0022*11*202608101029000001*20260810*062912~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*202608101029000001*00000000ND~NM1*IL*1*LITVIN*SEMYON****MI*SD13155S~N3*3101 OCEAN PARKWAY 4E~N4*BROOKLYN*NY*11235~DMG*D8*19410208*M~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=04~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*18*31894857411~REF*6P*0~LS*2120~NM1*P4*2*AARP*****PI*AP~N3*P O BOX 13999~N4*PHILADELPHIA*PA*191870216~PER*IC*PROVIDER SERVICES*TE*8005235880~LE*2120~EB*R*IND*30~REF*18*4E30Q35XR05~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*44*237838130~GE*1*237838130~IEA*1*237838130~