Import ›
271 Response
Eligibility Response Detail
CIN: SH63740C
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:13 PM
Payload ID: 97a16759-d248-454a-882a-4e3be80558bb
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: ELDERPLAN INC MAP
Received: Aug. 13, 2026 3:13 PM
Parser Version: 1.0
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1913*|*00501*648423933*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1913*423933*X*005010X279A1~ST*270*3933*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*SH63740C~EQ*30~DTP*291*D8*20260814~SE*13*3933~GE*1*423933~IEA*1*648423933~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1513*^*00501*536734330*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151339*536734330*X*005010X279A1~ST*271*536734330*005010X279A1~BHT*0022*11*202608131913000001*20260813*151339~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*DESCHAMPS*MARTHA*N***MI*SH63740C~N3*143 HIMROD ST 5P~N4*BROOKLYN*NY*11221~DMG*D8*19400809*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20251101~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*ELDERPLAN INC MAP*****PI*YL~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8778916447~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*R*IND*30~REF*6P*H3347~LS*2120~NM1*P4*2*ELDERPLAN*****PI*H3347~N3*ELDERPLAN INC 745 64TH STREET~N4*BROOKLYN*NY*11220~PER*IC*PROVIDER SERVICES*TE*8003533765~LE*2120~EB*R*IND*30~REF*18*4R16YN0KP61~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*41*536734330~GE*1*536734330~IEA*1*536734330~