Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*0705*|*00501*518343615*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0705*343615*X*005010X279A1~ST*270*3615*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*ZK64512Y~EQ*30~DTP*291*D8*20260812~SE*13*3615~GE*1*343615~IEA*1*518343615~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*0305*^*00501*167418230*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*030539*167418230*X*005010X279A1~ST*271*167418230*005010X279A1~BHT*0022*11*202608120705000001*20260812*030539~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*BENITEZ*RAMONA****MI*ZK64512Y~N3*55 SARATOGA AVE               4C~N4*BROOKLYN*NY*11233~DMG*D8*19520306*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*HEALTHFIRST HEALTH PLAN, INC*****PI*MH~N3*100 CHURCH ST FL 18~N4*NEW YORK*NY*100072601~PER*IC*PROVIDER SERVICES*TE*8888011660~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*R*IND*30~REF*6P*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN  PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*1XX8QY9QC20~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*41*167418230~GE*1*167418230~IEA*1*167418230~