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271 Response
Eligibility Response Detail
CIN: RF51864Z
Date of Service: Aug. 12, 2026
Submitted: Aug. 12, 2026 3:08 AM
Payload ID: a6418d58-ff82-47a0-8cc4-bd20b8eed8d1
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 3:08 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-06-30 | 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*0708*|*00501*518502698*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0708*502698*X*005010X279A1~ST*270*2698*005010X279A1~BHT*0022*13*202608120708000001*20260812*0708~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*202608120708000001*00000000ND~NM1*IL*1******MI*RF51864Z~EQ*30~DTP*291*D8*20260812~SE*13*2698~GE*1*502698~IEA*1*518502698~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*0308*^*00501*167567230*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*030818*167567230*X*005010X279A1~ST*271*167567230*005010X279A1~BHT*0022*11*202608120708000001*20260812*030818~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*202608120708000001*00000000ND~NM1*IL*1*GELLER*ZOYA****MI*RF51864Z~N3*94 EAST 1 STREET 2L~N4*NEW YORK*NY*10009~DMG*D8*19490708*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=06~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*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*2FA7NH4YY48~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*167567230~GE*1*167567230~IEA*1*167567230~