Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1912*|*00501*648363837*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1912*363837*X*005010X279A1~ST*270*3837*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*WM12680V~EQ*30~DTP*291*D8*20260814~SE*13*3837~GE*1*363837~IEA*1*648363837~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1512*^*00501*536488130*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151239*536488130*X*005010X279A1~ST*271*536488130*005010X279A1~BHT*0022*11*202608131912000001*20260813*151239~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*COLONHERNANDEZ*YOLANDA****MI*WM12680V~N3*179 THROOP AVE                602~N4*BROOKLYN*NY*11206~DMG*D8*19630316*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CNTY CD=66 523~LS*2120~NM1*Y2*2*HEALTH FIRST PHSP INC*****PI*SF~N3*100 CHURCH ST FL 18~N4*NEW YORK*NY*100072601~PER*IC*PROVIDER SERVICES*TE*8888011660~LE*2120~EB*B*IND*30***29*0~EB*1*IND*88~EB*W*IND*CQ~LS*2120~NM1*Y2*2*COMUNILIFE MENTAL HEALTH CL*****XX*1528082013~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*COORDINATED BEHAVIORAL CARE INC*****XX*1730451071~LE*2120~SE*37*536488130~GE*1*536488130~IEA*1*536488130~