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271 Response
Eligibility Response Detail
CIN: MA82925P
Date of Service: Aug. 6, 2026
Submitted: Aug. 10, 2026 6:36 AM
Payload ID: 61a7235b-7ba6-48fb-aa56-97f5bfb9b975
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: Community Coverage w/CBLTC
MCO: —
Received: Aug. 10, 2026 6:36 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-03-31 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| 1 | 30 | Community Coverage w/CBLTC | — | — | |
| B | 30 | — | — | — | |
| 1 | 1 | — | — | — | |
| 1 | 4 | — | — | — | |
| 1 | 5 | — | — | — | |
| 1 | 33 | — | — | — | |
| 1 | 35 | — | — | — | |
| 1 | 47 | — | — | — | |
| 1 | 48 | — | — | — | |
| 1 | 50 | — | — | — | |
| 1 | 86 | — | — | — | |
| 1 | 88 | — | — | — | |
| 1 | 98 | — | — | — | |
| 1 | AG | — | — | — | |
| 1 | AL | — | — | — | |
| 1 | MH | — | — | — | |
| 1 | UC | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260810*1036*|*00501*358167403*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1036*167403*X*005010X279A1~ST*270*7403*005010X279A1~BHT*0022*13*202608101036000001*20260810*1036~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*202608101036000001*00000000ND~NM1*IL*1******MI*MA82925P~EQ*30~DTP*291*D8*20260806~SE*13*7403~GE*1*167403~IEA*1*358167403~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260810*0636*^*00501*238384430*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*063603*238384430*X*005010X279A1~ST*271*238384430*005010X279A1~BHT*0022*11*202608101036000001*20260810*063603~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*202608101036000001*00000000ND~NM1*IL*1*ZADOROJNIUCWERNE*NATALIA****MI*MA82925P~N3*2029 2 AVENUE 19G~N4*NEW YORK*NY*10029~DMG*D8*19530922*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20251001~EB*1*IND*30**Community Coverage w/CBLTC~MSG*CNTY CD=66 525~MSG*RECERT MONTH=03~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*33~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AG~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~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*8EH0K81UX43~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*49*238384430~GE*1*238384430~IEA*1*238384430~