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271 Response
Eligibility Response Detail
CIN: UW73887P
Date of Service: July 27, 2026
Submitted: July 27, 2026 5:07 AM
Payload ID: 58dab659-d8ac-4b80-a246-57fc571bef6c
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: July 1, 2026 — —
Plan: Medicare Coinsurance Deductible Only
MCO: —
Received: July 27, 2026 5:07 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT_MONTH | 12 | MSG | MSG01 | Recertification month: 12 |
| 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 | Medicare Coinsurance Deductible Only | — | — | |
| B | 30 | — | — | — | |
| 1 | 1 | — | — | — | |
| 1 | 33 | — | — | — | |
| 1 | 35 | — | — | — | |
| 1 | 47 | — | — | — | |
| 1 | 48 | — | — | — | |
| 1 | 50 | — | — | — | |
| 1 | 86 | — | — | — | |
| 1 | 88 | — | — | — | |
| 1 | 98 | — | — | — | |
| 1 | AL | — | — | — | |
| 1 | MH | — | — | — | |
| 1 | UC | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260727*0907*|*00501*143237345*1*P*:~GS*HS*00ND*EMEDNYREL*20260727*0907*237345*X*005010X279A1~ST*270*7345*005010X279A1~BHT*0022*13*202607270907000001*20260727*0907~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*202607270907000001*00000000ND~NM1*IL*1******MI*UW73887P~EQ*30~DTP*291*D8*20260727~SE*13*7345~GE*1*237345~IEA*1*143237345~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260727*0507*^*00501*198135930*0*P*|~GS*HB*EMEDNYREL*00ND*20260727*050714*198135930*X*005010X279A1~ST*271*198135930*005010X279A1~BHT*0022*11*202607270907000001*20260727*050714~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*202607270907000001*00000000ND~NM1*IL*1*BYNOE*GERMAINE*B***MI*UW73887P~N3*18715 SULLIVAN ROAD~N4*SAINT ALBANS*NY*11412~DMG*D8*19410321*F~DTP*472*D8*20260727~DTP*346*D8*20260701~DTP*102*D8*20260701~EB*1*IND*30**Medicare Coinsurance Deductible Only~MSG*CF~MSG*PD~MSG*CNTY CD=66~MSG*RECERT MONTH=12~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*33~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*AL~EB*1*IND*MH~EB*1*IND*UC~EB*R*IND*30~REF*6P*H3347~LS*2120~NM1*P4*2*ELDERPLAN*****PI*H3347~N3*ELDERPLAN INC 745 64TH STREET~N4*BROOKLYN*NY*11220~PER*IC*PROVIDER SERVICES*TE*8003533765~LE*2120~EB*R*IND*30~REF*18*7J24P36GK89~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*48*198135930~GE*1*198135930~IEA*1*198135930~