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271 Response
Eligibility Response Detail
CIN: MD23376Z
Date of Service: Aug. 13, 2026
Submitted: Aug. 12, 2026 3:51 PM
Payload ID: b04d4a96-6a0d-45bc-9a06-cdf83a4300f6
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: NORTH SHORE UNIVERSITY HOSPITAL
Received: Aug. 12, 2026 3:51 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-02-28 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| W | CQ | — | — | — | |
| W | CQ | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*1951*|*00501*564290849*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1951*290849*X*005010X279A1~ST*270*0849*005010X279A1~BHT*0022*13*202608121951000001*20260812*1951~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*202608121951000001*00000000ND~NM1*IL*1******MI*MD23376Z~EQ*30~DTP*291*D8*20260813~SE*13*0849~GE*1*290849~IEA*1*564290849~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*1551*^*00501*528779230*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155126*528779230*X*005010X279A1~ST*271*528779230*005010X279A1~BHT*0022*11*202608121951000001*20260812*155126~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*202608121951000001*00000000ND~NM1*IL*1*AGUIRRE*LUISA****MI*MD23376Z~N3*85-52 106 STREET PVT~N4*QUEENS*NY*11418~DMG*D8*19450825*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260801~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*PD~MSG*CNTY CD=66 523~MSG*RECERT MONTH=02~LS*2120~NM1*Y2*2*HEALTHFIRST HEALTH PLAN, INC*****PI*MH~N3*100 CHURCH ST FL 18~N4*NEW YORK*NY*100072601~PER*IC*PROVIDER SERVICES*TE*8888011660~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*W*IND*CQ~LS*2120~NM1*Y2*2*NORTH SHORE UNIVERSITY HOSPITAL*****XX*1932472107~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*NORTH SHORE UNIVERSITY HOSPITAL*****XX*1932472107~LE*2120~EB*R*IND*30~REF*6P*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*6M19WR8GQ22~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*52*528779230~GE*1*528779230~IEA*1*528779230~