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271 Response
Eligibility Response Detail
CIN: WG74555R
Date of Service: Aug. 13, 2026
Submitted: Aug. 12, 2026 4:00 PM
Payload ID: 73676c3a-5aa9-4aef-9cb5-3ed036f45672
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: ELDERPLAN INC MAP
Received: Aug. 12, 2026 4:00 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-01-31 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*2000*|*00501*564822701*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2000*822701*X*005010X279A1~ST*270*2701*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*WG74555R~EQ*30~DTP*291*D8*20260813~SE*13*2701~GE*1*822701~IEA*1*564822701~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*1600*^*00501*531078230*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160018*531078230*X*005010X279A1~ST*271*531078230*005010X279A1~BHT*0022*11*202608122000000001*20260812*160018~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*MONSERRATE*GERARDO****MI*WG74555R~N3*2850 WEST 24H STREET 1A~N4*BROOKLYN*NY*11224~DMG*D8*19551226*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=01~LS*2120~NM1*Y2*2*ELDERPLAN INC MAP*****PI*YL~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8778916447~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~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*2EG3W95GF90~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*531078230~GE*1*531078230~IEA*1*531078230~