Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*0705*|*00501*518300238*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0705*300238*X*005010X279A1~ST*270*0238*005010X279A1~BHT*0022*13*202608120705000001*20260812*0705~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*202608120705000001*00000000ND~NM1*IL*1******MI*ZA63187K~EQ*30~DTP*291*D8*20260812~SE*13*0238~GE*1*300238~IEA*1*518300238~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*0304*^*00501*166377130*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*030455*166377130*X*005010X279A1~ST*271*166377130*005010X279A1~BHT*0022*11*202608120705000001*20260812*030455~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*202608120705000001*00000000ND~NM1*IL*1*ADAMSKY*TZILA****MI*ZA63187K~N3*440 NEPTUNE AVE               13D~N4*BKLYN*NY*11224~DMG*D8*19271127*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*5UH3PC9WF00~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*35*166377130~GE*1*166377130~IEA*1*166377130~