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271 Response
Eligibility Response Detail
CIN: VE40637P
Date of Service: Aug. 6, 2026
Submitted: Aug. 10, 2026 6:30 AM
Payload ID: 7be9c3f4-9400-4dc1-b573-3a576d610435
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 6:30 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-12-31 | 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 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260810*1030*|*00501*357820008*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1030*820008*X*005010X279A1~ST*270*0008*005010X279A1~BHT*0022*13*202608101030000001*20260810*1030~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*202608101030000001*00000000ND~NM1*IL*1******MI*VE40637P~EQ*30~DTP*291*D8*20260806~SE*13*0008~GE*1*820008~IEA*1*357820008~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260810*0630*^*00501*237939730*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*063015*237939730*X*005010X279A1~ST*271*237939730*005010X279A1~BHT*0022*11*202608101030000001*20260810*063015~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*202608101030000001*00000000ND~NM1*IL*1*MOROZ*INNA****MI*VE40637P~N3*2435 OCEAN AVENUE 5A~N4*BROOKLYN*NY*11229~DMG*D8*19730704*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=12~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*5XD6GE5YX59~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*34*237939730~GE*1*237939730~IEA*1*237939730~