Import ›
271 Response
Eligibility Response Detail
CIN: XH16561K
Date of Service: Aug. 13, 2026
Submitted: Aug. 12, 2026 3:58 PM
Payload ID: a71efb24-3ec6-45af-a3a7-e5dd93b4932c
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 3:58 PM
Parser Version: 1.0
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| 1 | 88 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*1958*|*00501*564730333*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1958*730333*X*005010X279A1~ST*270*0333*005010X279A1~BHT*0022*13*202608121958000001*20260812*1958~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*202608121958000001*00000000ND~NM1*IL*1******MI*XH16561K~EQ*30~DTP*291*D8*20260813~SE*13*0333~GE*1*730333~IEA*1*564730333~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*1558*^*00501*530524530*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155845*530524530*X*005010X279A1~ST*271*530524530*005010X279A1~BHT*0022*11*202608121958000001*20260812*155845~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*202608121958000001*00000000ND~NM1*IL*1*LARA*ISAMARIE*K***MI*XH16561K~N3*3026 BAINBRIDE AVE 1C~N4*BRONX*NY*10458~DMG*D8*19900504*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~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~SE*29*530524530~GE*1*530524530~IEA*1*530524530~