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271 Response
Eligibility Response Detail
CIN: ZM08921F
Date of Service: Aug. 13, 2026
Submitted: Aug. 12, 2026 4:00 PM
Payload ID: 2f137c02-f1c7-4e66-bcb0-92c5ba46d0df
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: SOUTHWEST BROOKLYN HEALTH HOME LLC
Received: Aug. 12, 2026 4:00 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-09-30 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| W | CQ | — | — | — | |
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| 1 | 88 | — | — | — | |
| W | CQ | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*2000*|*00501*564844452*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2000*844452*X*005010X279A1~ST*270*4452*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*ZM08921F~EQ*30~DTP*291*D8*20260813~SE*13*4452~GE*1*844452~IEA*1*564844452~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*1600*^*00501*531469630*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160040*531469630*X*005010X279A1~ST*271*531469630*005010X279A1~BHT*0022*11*202608122000000001*20260812*160040~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*OQUENDO*MARIA****MI*ZM08921F~N3*840 HEGEMAN AVENUE 2A~N4*BROOKLYN*NY*11207~DMG*D8*19471006*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=09~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*W*IND*CQ~LS*2120~NM1*Y2*2*DORAL MEDICAL & MULTI SPECIALTY FAC*****XX*1144693607~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*SOUTHWEST BROOKLYN HEALTH HOME LLC*****XX*1023354933~LE*2120~EB*R*IND*30~REF*6P*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*8K13W31QX88~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*53*531469630~GE*1*531469630~IEA*1*531469630~