Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2006*|*00501*565161802*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2006*161802*X*005010X279A1~ST*270*1802*005010X279A1~BHT*0022*13*202608122006000001*20260812*2006~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*202608122006000001*00000000ND~NM1*IL*1******MI*ZE83841G~EQ*30~DTP*291*D8*20260813~SE*13*1802~GE*1*161802~IEA*1*565161802~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1605*^*00501*534059530*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160557*534059530*X*005010X279A1~ST*271*534059530*005010X279A1~BHT*0022*11*202608122006000001*20260812*160557~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*202608122006000001*00000000ND~NM1*IL*1*WINFIELD*BOBBY*L***MI*ZE83841G~N3*15501 90TH AVE                5E~N4*JAMAICA*NY*11432~DMG*D8*19640523*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*VILLAGE SENIOR SERVICES CORP MAP*****PI*VM~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*R*IND*30~REF*6P*H2168~LS*2120~NM1*P4*2*VILLAGECAREMAX MEDICARE TOTAL ADVAN*****PI*H2168~N3*P O  BOX 5426~N4*HAUPPAUGE*NY*117885426~PER*IC*PROVIDER SERVICES*TE*8004696292~LE*2120~EB*R*IND*30~REF*18*3VT7QX8JP64~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*41*534059530~GE*1*534059530~IEA*1*534059530~