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271 Response
Eligibility Response Detail
CIN: WC61958Q
Date of Service: Aug. 12, 2026
Submitted: Aug. 12, 2026 3:10 AM
Payload ID: 635e8811-5dc3-4c4e-8e8a-a3f176951c48
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 3:10 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-12-31 | 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 | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*0710*|*00501*518616568*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0710*616568*X*005010X279A1~ST*270*6568*005010X279A1~BHT*0022*13*202608120710000001*20260812*0710~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*202608120710000001*00000000ND~NM1*IL*1******MI*WC61958Q~EQ*30~DTP*291*D8*20260812~SE*13*6568~GE*1*616568~IEA*1*518616568~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*0310*^*00501*167873830*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*031012*167873830*X*005010X279A1~ST*271*167873830*005010X279A1~BHT*0022*11*202608120710000001*20260812*031012~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*202608120710000001*00000000ND~NM1*IL*1*KATZ*MICHAEL****MI*WC61958Q~N3*20 QUINCY AVE~N4*STATEN ISLAND*NY*10305~DMG*D8*19590413*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20251201~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=12~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*9013227301~REF*6P*01~LS*2120~NM1*P4*2*1199 SEIU NATIONAL BEN FUND*****PI*LO~N3*310 W 43RD ST~N4*NEW YORK*NY*10036~PER*IC*PROVIDER SERVICES*TE*6464737160~LE*2120~EB*R*IND*30~REF*18*K1243563202~REF*6P*1124328~LS*2120~NM1*P4*2*EMBLEM HEALTH (DENTAL)*****PI*HEMD~N3*PO BOX 463~N4*MILWAKEE*WI*532010463~PER*IC*PROVIDER SERVICES*TE*8006242414~LE*2120~EB*R*IND*30~REF*18*10980779502~REF*6P*RX23MD~LS*2120~NM1*P4*2*CAREMARK (CVS)*****PI*DV~N3*POST OFFICE BOX 52057~N4*PHOENIX*AZ*850722057~PER*IC*PROVIDER SERVICES*TE*8006245060~LE*2120~EB*R*IND*30~REF*18*6TQ9K16GM39~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*63*167873830~GE*1*167873830~IEA*1*167873830~