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271 Response
Eligibility Response Detail
CIN: UY62363N
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:15 PM
Payload ID: fdf455f3-fd91-45ca-bccc-b1352501ba3c
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 3:15 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-07-31 | 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 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1915*|*00501*648514119*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1915*514119*X*005010X279A1~ST*270*4119*005010X279A1~BHT*0022*13*202608131915000001*20260813*1915~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*202608131915000001*00000000ND~NM1*IL*1******MI*UY62363N~EQ*30~DTP*291*D8*20260814~SE*13*4119~GE*1*514119~IEA*1*648514119~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1515*^*00501*537115130*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151509*537115130*X*005010X279A1~ST*271*537115130*005010X279A1~BHT*0022*11*202608131915000001*20260813*151509~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*202608131915000001*00000000ND~NM1*IL*1*VELEZ*ELISA****MI*UY62363N~N3*762 E 220TH ST~N4*BRONX*NY*10467~DMG*D8*19371105*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20251101~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=07~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*2AV4YC3HF99~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*537115130~GE*1*537115130~IEA*1*537115130~