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271 Response
Eligibility Response Detail
CIN: SM63259P
Date of Service: Aug. 13, 2026
Submitted: Aug. 12, 2026 4:06 PM
Payload ID: 35f92879-7b91-499e-a4d5-e6921fb41a2e
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: COORDINATED BEHAVIORAL CARE INC
Received: Aug. 12, 2026 4:06 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-11-30 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| W | CQ | — | — | — | |
| W | CQ | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*2006*|*00501*565217299*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2006*217299*X*005010X279A1~ST*270*7299*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*SM63259P~EQ*30~DTP*291*D8*20260813~SE*13*7299~GE*1*217299~IEA*1*565217299~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*1606*^*00501*534263230*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160652*534263230*X*005010X279A1~ST*271*534263230*005010X279A1~BHT*0022*11*202608122006000001*20260812*160652~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*SALVA*VICTOR****MI*SM63259P~N3*1441 BOSTON ROAD 2H~N4*BRONX*NY*10460~DMG*D8*19460720*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260120~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=11~LS*2120~NM1*Y2*2*HEALTHFIRST HEALTH PLAN, INC*****PI*MH~N3*100 CHURCH ST FL 18~N4*NEW YORK*NY*100072601~PER*IC*PROVIDER SERVICES*TE*8888011660~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*W*IND*CQ~LS*2120~NM1*Y2*2*METRO CARE MANAGEMENT LLC*****XX*1922565118~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*COORDINATED BEHAVIORAL CARE INC*****XX*1730451071~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*9A04D08YF92~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*52*534263230~GE*1*534263230~IEA*1*534263230~