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271 Response
Eligibility Response Detail
CIN: WH17943B
Date of Service: Aug. 12, 2026
Submitted: Aug. 12, 2026 3:13 AM
Payload ID: 282a27af-0538-463d-99f9-97eb732a2569
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: SENIOR WHOLE HEALTH OF NY PARTIAL
Received: Aug. 12, 2026 3:13 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| S1 | S1 | S1 | MSG | MSG01 | S1 exemption code found in MSG segment |
| Recertification | RECERT | 2026-10-31 | 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 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*0713*|*00501*518809004*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0713*809004*X*005010X279A1~ST*270*9004*005010X279A1~BHT*0022*13*202608120713000001*20260812*0713~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*202608120713000001*00000000ND~NM1*IL*1******MI*WH17943B~EQ*30~DTP*291*D8*20260812~SE*13*9004~GE*1*809004~IEA*1*518809004~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*0313*^*00501*173377530*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*031324*173377530*X*005010X279A1~ST*271*173377530*005010X279A1~BHT*0022*11*202608120713000001*20260812*031324~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*202608120713000001*00000000ND~NM1*IL*1*MUNOR*BORIS****MI*WH17943B~N3*181-18 TUTOR RD~N4*JAMAICA*NY*11432~DMG*D8*19500413*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260601~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H5599~LS*2120~NM1*P4*2*WELLCARE FIDELIS DUAL ACCESS*****PI*H5599~N3*25-01 JACKSON AVE~N4*LONG ISLAND CITY*NY*11101~PER*IC*PROVIDER SERVICES*TE*8883433547~LE*2120~EB*R*IND*30~REF*18*4TP3T84TK88~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*173377530~GE*1*173377530~IEA*1*173377530~