Import ›
271 Response
Eligibility Response Detail
CIN: ZZ65278P
Date of Service: Aug. 12, 2026
Submitted: Aug. 12, 2026 3:06 AM
Payload ID: bf26297f-391a-4113-a1d4-1288ab3c76f0
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: ELDERSERVE HEALTH INC MLTCP
Received: Aug. 12, 2026 3:06 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-04-30 | 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 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*0706*|*00501*518370289*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0706*370289*X*005010X279A1~ST*270*0289*005010X279A1~BHT*0022*13*202608120706000001*20260812*0706~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*202608120706000001*00000000ND~NM1*IL*1******MI*ZZ65278P~EQ*30~DTP*291*D8*20260812~SE*13*0289~GE*1*370289~IEA*1*518370289~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*0306*^*00501*167445230*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*030605*167445230*X*005010X279A1~ST*271*167445230*005010X279A1~BHT*0022*11*202608120706000001*20260812*030605~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*202608120706000001*00000000ND~NM1*IL*1*BROOKS*STELLA****MI*ZZ65278P~N3*1481 WASHINGTON AVE 13D~N4*BRONX*NY*10456~DMG*D8*19500305*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~MSG*RECERT MONTH=04~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*6P*H3387~LS*2120~NM1*P4*2*UNITEDHEALTHCARE DUAL COMPLETE*****PI*H3387~N3*P O BOX 917~N4*NEW YORK*NY*10269~PER*IC*PROVIDER SERVICES*TE*8005144912~LE*2120~EB*R*IND*30~REF*18*2MG7PT7RG59~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*44*167445230~GE*1*167445230~IEA*1*167445230~