Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1911*|*00501*648283462*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1911*283462*X*005010X279A1~ST*270*3462*005010X279A1~BHT*0022*13*202608131911000001*20260813*1911~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*202608131911000001*00000000ND~NM1*IL*1******MI*KQ18700Z~EQ*30~DTP*291*D8*20260814~SE*13*3462~GE*1*283462~IEA*1*648283462~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1511*^*00501*536163030*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151119*536163030*X*005010X279A1~ST*271*536163030*005010X279A1~BHT*0022*11*202608131911000001*20260813*151119~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*202608131911000001*00000000ND~NM1*IL*1*MARGVELASHVILI*GIGA****MI*KQ18700Z~N3*2215 AVENUE V 1 FL~N4*BROOKLYN*NY*11229~DMG*D8*19660627*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260801~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*PD~MSG*CNTY CD=66 500~LS*2120~NM1*Y2*2*ANTHEM HP LLC MAINSTREAM*****PI*KP~N3*1 PENN PLZ FL 35~N4*NEW YORK*NY*101193601~PER*IC*PROVIDER SERVICES*TE*2125635570~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*JEMCARE LLC*****XX*1265926216~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*COMMUNITY CARE MANAGEMENT PARTNERS*****XX*1366780850~LE*2120~SE*39*536163030~GE*1*536163030~IEA*1*536163030~