Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1911*|*00501*648299562*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1911*299562*X*005010X279A1~ST*270*9562*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*WA65486U~EQ*30~DTP*291*D8*20260814~SE*13*9562~GE*1*299562~IEA*1*648299562~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1511*^*00501*536235430*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151135*536235430*X*005010X279A1~ST*271*536235430*005010X279A1~BHT*0022*11*202608131911000001*20260813*151135~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*MOTA*GILMA*A***MI*WA65486U~N3*875 W 181 ST                  3G~N4*NEW YORK*NY*10033~DMG*D8*19460217*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~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*18*5TN6ET0MT73~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*33*536235430~GE*1*536235430~IEA*1*536235430~