Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1035*|*00501*358116344*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1035*116344*X*005010X279A1~ST*270*6344*005010X279A1~BHT*0022*13*202608101035000001*20260810*1035~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*202608101035000001*00000000ND~NM1*IL*1******MI*QK20978K~EQ*30~DTP*291*D8*20260806~SE*13*6344~GE*1*116344~IEA*1*358116344~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0635*^*00501*238333530*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*063512*238333530*X*005010X279A1~ST*271*238333530*005010X279A1~BHT*0022*11*202608101035000001*20260810*063512~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*202608101035000001*00000000ND~NM1*IL*1*VERKHOVANETS*GANNA****MI*QK20978K~N3*2621 BROWN STREET 2ND FLOOR~N4*BROOKLYN*NY*11235~DMG*D8*19450220*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20251201~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~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*9RR4HT3QE04~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*34*238333530~GE*1*238333530~IEA*1*238333530~