Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1915*|*00501*648515820*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1915*515820*X*005010X279A1~ST*270*5820*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*YU22837J~EQ*30~DTP*291*D8*20260814~SE*13*5820~GE*1*515820~IEA*1*648515820~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1515*^*00501*537122530*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151511*537122530*X*005010X279A1~ST*271*537122530*005010X279A1~BHT*0022*11*202608131915000001*20260813*151511~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*WILSON*RONALD*G***MI*YU22837J~N3*550 E 170TH STREET            4L~N4*BRONX*NY*10456~DMG*D8*19420109*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*8RK4JY7QX95~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*34*537122530~GE*1*537122530~IEA*1*537122530~