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271 Response
Eligibility Response Detail
CIN: XA34373W
Date of Service: July 27, 2026
Submitted: July 27, 2026 4:18 AM
Payload ID: d084f685-230f-41f8-8ad9-285b4300ea4d
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: July 1, 2026 — —
Plan: Community Coverage w/CBLTC
MCO: —
Received: July 27, 2026 4:18 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT_MONTH | 09 | MSG | MSG01 | Recertification month: 09 |
| Surplus | EB_COPAY | 0 | EB | EB08 | Surplus/co-payment amount $0 from EB segment |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| 1 | 30 | Community Coverage w/CBLTC | — | — | |
| B | 30 | — | — | — | |
| 1 | 1 | — | — | — | |
| 1 | 4 | — | — | — | |
| 1 | 5 | — | — | — | |
| 1 | 35 | — | — | — | |
| 1 | 47 | — | — | — | |
| 1 | 48 | — | — | — | |
| 1 | 50 | — | — | — | |
| 1 | 86 | — | — | — | |
| 1 | 88 | — | — | — | |
| 1 | 98 | — | — | — | |
| 1 | AG | — | — | — | |
| 1 | AL | — | — | — | |
| 1 | MH | — | — | — | |
| 1 | UC | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260727*0818*|*00501*140311338*1*P*:~GS*HS*00ND*EMEDNYREL*20260727*0818*311338*X*005010X279A1~ST*270*1338*005010X279A1~BHT*0022*13*202607270818000001*20260727*0818~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*202607270818000001*00000000ND~NM1*IL*1******MI*XA34373W~EQ*30~DTP*291*D8*20260727~SE*13*1338~GE*1*311338~IEA*1*140311338~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260727*0418*^*00501*190203030*0*P*|~GS*HB*EMEDNYREL*00ND*20260727*041828*190203030*X*005010X279A1~ST*271*190203030*005010X279A1~BHT*0022*11*202607270818000001*20260727*041828~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*202607270818000001*00000000ND~NM1*IL*1*KARIMOVA*ALFIYA****MI*XA34373W~N3*435 NEPTUNE AVENUE 12B~N4*BROOKLYN*NY*11224~DMG*D8*19600522*F~DTP*472*D8*20260727~DTP*346*D8*20260701~DTP*102*D8*20260601~EB*1*IND*30**Community Coverage w/CBLTC~MSG*CNTY CD=66 521~MSG*RECERT MONTH=09~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AG~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~EB*R*IND*30~REF*18*12479~REF*6P*1735496~LS*2120~NM1*P4*2*UNITED HEALTH CARE (DENTAL)*****PI*F7D~N3*PO BOX 30560~N4*BETHESDA*MD*208240560~PER*IC*PROVIDER SERVICES*TE*8668776187~LE*2120~EB*R*IND*30~REF*18*9KC9KY4YT44~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*49*190203030~GE*1*190203030~IEA*1*190203030~