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271 Response
Eligibility Response Detail
CIN: UT87939B
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:13 PM
Payload ID: 388e2f89-6542-433d-a9e1-f247af2f9c50
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: CATHOLIC MANAGED LONG T C PACE INC
Received: Aug. 13, 2026 3:13 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| S1 | S1 | S1 | MSG | MSG01 | S1 exemption code found in MSG segment |
| Recertification | RECERT | 2026-08-31 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1913*|*00501*648386657*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1913*386657*X*005010X279A1~ST*270*6657*005010X279A1~BHT*0022*13*202608131913000001*20260813*1913~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*202608131913000001*00000000ND~NM1*IL*1******MI*UT87939B~EQ*30~DTP*291*D8*20260814~SE*13*6657~GE*1*386657~IEA*1*648386657~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1513*^*00501*536574430*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151302*536574430*X*005010X279A1~ST*271*536574430*005010X279A1~BHT*0022*11*202608131913000001*20260813*151302~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*202608131913000001*00000000ND~NM1*IL*1*NELSON*HILDRA****MI*UT87939B~N3*70 EAST 115TH ST 7J~N4*NEW YORK*NY*10029~DMG*D8*19380614*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=08~LS*2120~NM1*Y2*2*CATHOLIC MANAGED LONG T C PACE INC*****PI*AC~N3*205 LEXINGTON AVE FL~N4*NEW YORK*NY*100166053~PER*IC*PROVIDER SERVICES*TE*6466334702~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*R*IND*30~REF*18*4H47X27UG57~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*35*536574430~GE*1*536574430~IEA*1*536574430~