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271 Response
Eligibility Response Detail
CIN: KX47925P
Date of Service: Aug. 13, 2026
Submitted: Aug. 12, 2026 3:54 PM
Payload ID: 1f820ff5-a724-41e4-949e-c6f7cedd2e42
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: CENTERLIGHT HEALTHCARE PACE
Received: Aug. 12, 2026 3:54 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-01-31 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | $50.00 | — | |
| 1 | 82 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*1954*|*00501*564477045*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1954*477045*X*005010X279A1~ST*270*7045*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*KX47925P~EQ*30~DTP*291*D8*20260813~SE*13*7045~GE*1*477045~IEA*1*564477045~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*1554*^*00501*529571930*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155432*529571930*X*005010X279A1~ST*271*529571930*005010X279A1~BHT*0022*11*202608121954000001*20260812*155432~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*CUPO*JOSEPH****MI*KX47925P~N3*35A CLIFTON AVENUE A~N4*STATEN ISLAND*NY*10305~DMG*D8*19380122*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260201~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 523~MSG*RECERT MONTH=01~LS*2120~NM1*Y2*2*CENTERLIGHT HEALTHCARE PACE*****PI*C7~N3*136-65 37TH AVE~N4*FLUSHING*NY*113544110~PER*IC*PROVIDER SERVICES*TE*8772268500~LE*2120~EB*B*IND*30***29*50~EB*1*IND*82~EB*R*IND*30~REF*18*1HA6QN6AY30~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*34*529571930~GE*1*529571930~IEA*1*529571930~