Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2005*|*00501*565147005*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2005*147005*X*005010X279A1~ST*270*7005*005010X279A1~BHT*0022*13*202608122005000001*20260812*2005~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*202608122005000001*00000000ND~NM1*IL*1******MI*TW43020T~EQ*30~DTP*291*D8*20260813~SE*13*7005~GE*1*147005~IEA*1*565147005~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1605*^*00501*534009330*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160542*534009330*X*005010X279A1~ST*271*534009330*005010X279A1~BHT*0022*11*202608122005000001*20260812*160542~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*202608122005000001*00000000ND~NM1*IL*1*WILLIAMS*CARROL****MI*TW43020T~N3*237      NASSAU STREET        3C~N4*BROOKLYN*NY*11201~DMG*D8*19690202*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260701~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*ELDERPLAN INC HOMEFIRST PARTIAL LTC*****PI*ED~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8777711119~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H3387~LS*2120~NM1*P4*2*UNITEDHEALTHCARE DUAL COMPLETE*****PI*H3387~N3*P O BOX 917~N4*NEW YORK*NY*10269~PER*IC*PROVIDER SERVICES*TE*8005144912~LE*2120~EB*R*IND*30~REF*18*8HR6EV7NN82~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*41*534009330~GE*1*534009330~IEA*1*534009330~