Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2007*|*00501*565274928*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2007*274928*X*005010X279A1~ST*270*4928*005010X279A1~BHT*0022*13*202608122007000001*20260812*2007~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*202608122007000001*00000000ND~NM1*IL*1******MI*XV93820N~EQ*30~DTP*291*D8*20260813~SE*13*4928~GE*1*274928~IEA*1*565274928~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1607*^*00501*534466330*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160750*534466330*X*005010X279A1~ST*271*534466330*005010X279A1~BHT*0022*11*202608122007000001*20260812*160750~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*202608122007000001*00000000ND~NM1*IL*1*TOLIAFERRO*JOHN*M***MI*XV93820N~N3*2949 FRDRK DGLSS BLVD         13E~N4*NEW YORK*NY*10039~DMG*D8*19540314*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*CNTY CD=66 5H9~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*UPPER MANHATTAN MNTL HLTH CTR*****XX*1053335620~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*NEW YORK CITY HLTH & HOSP CORP*****XX*1114558509~LE*2120~EB*R*IND*30~REF*6P*H3312~LS*2120~NM1*P4*2*AETNA MEDICARE*****PI*H3312~N3*151 FARMINGTON AVENUE~N4*HARTFORD*CT*06156~PER*IC*PROVIDER SERVICES*TE*8002825366~LE*2120~EB*R*IND*30~REF*18*7AC0K99VA39~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*52*534466330~GE*1*534466330~IEA*1*534466330~