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271 Response
Eligibility Response Detail
CIN: SS58072N
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:10 PM
Payload ID: 37ea5343-7a79-4b93-a6cd-cfb4eec6f9cb
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: ANTHEM HP LLC PARTIAL MLTC
Received: Aug. 13, 2026 3:10 PM
Parser Version: 1.0
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| 1 | 88 | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1910*|*00501*648240860*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1910*240860*X*005010X279A1~ST*270*0860*005010X279A1~BHT*0022*13*202608131910000001*20260813*1910~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*202608131910000001*00000000ND~NM1*IL*1******MI*SS58072N~EQ*30~DTP*291*D8*20260814~SE*13*0860~GE*1*240860~IEA*1*648240860~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1510*^*00501*535082630*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151036*535082630*X*005010X279A1~ST*271*535082630*005010X279A1~BHT*0022*11*202608131910000001*20260813*151036~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*202608131910000001*00000000ND~NM1*IL*1*BRAGINSKIY*TATYANA****MI*SS58072N~N3*40 BRIGHTON FIRST RD 11J~N4*BROOKLYN*NY*11235~DMG*D8*19590206*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260801~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*ANTHEM HP LLC PARTIAL MLTC*****PI*KX~N3*ONE PENN PLZ FL 35~N4*NEW YORK*NY*101190000~PER*IC*PROVIDER SERVICES*TE*2125635570~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~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*1R08C19MM30~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*535082630~GE*1*535082630~IEA*1*535082630~