Import ›
271 Response
Eligibility Response Detail
CIN: YX34046Y
Date of Service: Aug. 13, 2026
Submitted: Aug. 12, 2026 3:55 PM
Payload ID: 3929a48a-2e29-4eb5-b640-553c81d2272d
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: SOUTHWEST BROOKLYN HEALTH HOME LLC
Received: Aug. 12, 2026 3:55 PM
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 | 2027-03-31 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| W | CQ | — | — | — | |
| W | CQ | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*1955*|*00501*564529092*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1955*529092*X*005010X279A1~ST*270*9092*005010X279A1~BHT*0022*13*202608121955000001*20260812*1955~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*202608121955000001*00000000ND~NM1*IL*1******MI*YX34046Y~EQ*30~DTP*291*D8*20260813~SE*13*9092~GE*1*529092~IEA*1*564529092~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*1555*^*00501*529771630*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155524*529771630*X*005010X279A1~ST*271*529771630*005010X279A1~BHT*0022*11*202608121955000001*20260812*155524~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*202608121955000001*00000000ND~NM1*IL*1*EADDY*MICHAEL****MI*YX34046Y~N3*109 LEWIS AVENUE 1K~N4*BROOKLYN*NY*11206~DMG*D8*19560915*M~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*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=03~LS*2120~NM1*Y2*2*ANTHEM HP LLC MAP*****PI*YO~N3*1 PENN PLZ FL 35~N4*NEW YORK*NY*101193601~PER*IC*PROVIDER SERVICES*TE*2125635570~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*W*IND*CQ~LS*2120~NM1*Y2*2*PUERTO RICAN FAMILY INST MH*****XX*1588873327~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*SOUTHWEST BROOKLYN HEALTH HOME LLC*****XX*1023354933~LE*2120~EB*R*IND*30~REF*6P*H8432~LS*2120~NM1*P4*2*EMPIRE MEDIBLUE CORE*****PI*H8432~N3*EMPIRE MEDIBLUE*PO BOX 1407 CHURCH STREET STATION~N4*NEW YORK*NY*100081407~PER*IC*PROVIDER SERVICES*TE*8557311090~LE*2120~EB*R*IND*30~REF*18*7EN1UH4VU04~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*53*529771630~GE*1*529771630~IEA*1*529771630~