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271 Response
Eligibility Response Detail
CIN: UN30578Q
Date of Service: Aug. 13, 2026
Submitted: Aug. 12, 2026 3:54 PM
Payload ID: 6dd35ad0-51ee-41a0-899d-d6648103f2d8
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: ANTHEM HP LLC PARTIAL MLTC
Received: Aug. 12, 2026 3:54 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-11-30 | 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 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*1954*|*00501*564462031*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1954*462031*X*005010X279A1~ST*270*2031*005010X279A1~BHT*0022*13*202608121954000001*20260812*1954~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*202608121954000001*00000000ND~NM1*IL*1******MI*UN30578Q~EQ*30~DTP*291*D8*20260813~SE*13*2031~GE*1*462031~IEA*1*564462031~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*1554*^*00501*529519630*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155417*529519630*X*005010X279A1~ST*271*529519630*005010X279A1~BHT*0022*11*202608121954000001*20260812*155417~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*202608121954000001*00000000ND~NM1*IL*1*CROSSE*SHAVONNA****MI*UN30578Q~N3*538 THATFORD AVENUE 1 FL~N4*BROOKLYN*NY*11212~DMG*D8*19890726*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=11~LS*2120~NM1*Y2*2*ANTHEM HP LLC PARTIAL MLTC*****PI*KX~N3*ONE PENN PLZ FL 35~N4*NEW YORK*NY*101190000~PER*IC*PROVIDER SERVICES*TE*2125635570~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*9800486355~REF*6P*1199RX~LS*2120~NM1*P4*2*EXPRESS SCRIPTS*****PI*EXS~N3*PO BOX 2863~N4*CLINTON*IA*527332863~PER*IC*PROVIDER SERVICES*TE*8002064005~LE*2120~SE*38*529519630~GE*1*529519630~IEA*1*529519630~