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271 Response
Eligibility Response Detail
CIN: MB22890S
Date of Service: Aug. 13, 2026
Submitted: Aug. 12, 2026 4:07 PM
Payload ID: 669e0828-f495-4782-a431-c523cf484ffa
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: VILLAGE SENIOR SERVICES CORP MAP
Received: Aug. 12, 2026 4:07 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-08-31 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*2007*|*00501*565275929*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2007*275929*X*005010X279A1~ST*270*5929*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*MB22890S~EQ*30~DTP*291*D8*20260813~SE*13*5929~GE*1*275929~IEA*1*565275929~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*1607*^*00501*534470330*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160751*534470330*X*005010X279A1~ST*271*534470330*005010X279A1~BHT*0022*11*202608122007000001*20260812*160751~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*TOLLESONJR*HARRIS****MI*MB22890S~N3*488 EAST 163 STREET 9E~N4*BRONX*NY*10451~DMG*D8*19700103*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260701~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=08~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*1U91JW6JG93~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*534470330~GE*1*534470330~IEA*1*534470330~