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271 Response
Eligibility Response Detail
CIN: SJ98139D
Date of Service: Aug. 13, 2026
Submitted: Aug. 12, 2026 4:00 PM
Payload ID: 7fa847a2-e875-43d7-b15d-6e55134cb09e
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: VILLAGE SENIOR SVC CORP PARTIAL LTC
Received: Aug. 12, 2026 4:00 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 | 2027-02-28 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| 1 | 88 | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*2000*|*00501*564817426*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2000*817426*X*005010X279A1~ST*270*7426*005010X279A1~BHT*0022*13*202608122000000001*20260812*2000~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*202608122000000001*00000000ND~NM1*IL*1******MI*SJ98139D~EQ*30~DTP*291*D8*20260813~SE*13*7426~GE*1*817426~IEA*1*564817426~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*1600*^*00501*530956430*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160013*530956430*X*005010X279A1~ST*271*530956430*005010X279A1~BHT*0022*11*202608122000000001*20260812*160013~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*202608122000000001*00000000ND~NM1*IL*1*MINUEZA*ROLANDO****MI*SJ98139D~N3*110-52 SUTPHIN BLVD 2F~N4*JAMAICA*NY*11435~DMG*D8*19450622*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=02~LS*2120~NM1*Y2*2*VILLAGE SENIOR SVC CORP PARTIAL LTC*****PI*VL~N3*112 CHARLES ST FL 2~N4*NEW YORK*NY*100142653~PER*IC*PROVIDER SERVICES*TE*8557692500~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H4868~LS*2120~NM1*P4*2*WELLCARE*****PI*H4868~N3*PO BOX 25885~N4*TAMPA*FL*33622~PER*IC*PROVIDER SERVICES*TE*8002785155~LE*2120~EB*R*IND*30~REF*18*7GY9RK2CT12~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*45*530956430~GE*1*530956430~IEA*1*530956430~