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271 Response
Eligibility Response Detail
CIN: XG61189B
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:12 PM
Payload ID: 594161c7-728d-43ee-8fb1-b0c5ea038ce7
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 3:12 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*1912*|*00501*648359904*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1912*359904*X*005010X279A1~ST*270*9904*005010X279A1~BHT*0022*13*202608131912000001*20260813*1912~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*202608131912000001*00000000ND~NM1*IL*1******MI*XG61189B~EQ*30~DTP*291*D8*20260814~SE*13*9904~GE*1*359904~IEA*1*648359904~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1512*^*00501*536474130*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151235*536474130*X*005010X279A1~ST*271*536474130*005010X279A1~BHT*0022*11*202608131912000001*20260813*151235~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*202608131912000001*00000000ND~NM1*IL*1*WALLACE*ENRIQUE****MI*XG61189B~N3*1 JACOBUS PL B32~N4*BRONX*NY*10463~DMG*D8*19660420*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 014~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*H2775~LS*2120~NM1*P4*2*WELLCARE*****PI*H2775~N3*4888 LOOP CENTRAL DR SUITE 300~N4*HOUSTON*TX*77081~PER*IC*PROVIDER SERVICES*TE*8664225009~LE*2120~EB*R*IND*30~REF*18*1DU3Q98YP05~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*536474130~GE*1*536474130~IEA*1*536474130~