Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*0707*|*00501*518445358*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0707*445358*X*005010X279A1~ST*270*5358*005010X279A1~BHT*0022*13*202608120707000001*20260812*0707~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*202608120707000001*00000000ND~NM1*IL*1******MI*QW35585E~EQ*30~DTP*291*D8*20260812~SE*13*5358~GE*1*445358~IEA*1*518445358~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*0307*^*00501*167514830*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*030721*167514830*X*005010X279A1~ST*271*167514830*005010X279A1~BHT*0022*11*202608120707000001*20260812*030721~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*202608120707000001*00000000ND~NM1*IL*1*DYM*TADEUSZ****MI*QW35585E~N3*9952 66TH ROAD                1-O~N4*REGO PARK*NY*11374~DMG*D8*19490128*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~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*18*7HF9WY4UU47~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*35*167514830~GE*1*167514830~IEA*1*167514830~