Import ›
271 Response
Eligibility Response Detail
CIN: WW59754D
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:16 PM
Payload ID: fe783b3a-9b68-4d62-b90c-bead5cb731ef
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: MONTEFIORE MEDICAL CENTER
Received: Aug. 13, 2026 3:16 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-12-31 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| W | CQ | — | — | — | |
| W | CQ | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1916*|*00501*648618192*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1916*618192*X*005010X279A1~ST*270*8192*005010X279A1~BHT*0022*13*202608131916000001*20260813*1916~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*202608131916000001*00000000ND~NM1*IL*1******MI*WW59754D~EQ*30~DTP*291*D8*20260814~SE*13*8192~GE*1*618192~IEA*1*648618192~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1516*^*00501*537570930*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151653*537570930*X*005010X279A1~ST*271*537570930*005010X279A1~BHT*0022*11*202608131916000001*20260813*151653~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*202608131916000001*00000000ND~NM1*IL*1*HEYER*DAVID****MI*WW59754D~N3*153 E 165 ST 1D~N4*BRONX*NY*10452~DMG*D8*19490112*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*H9~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=12~LS*2120~NM1*Y2*2*HEALTHFIRST HEALTH PLAN, INC*****PI*MH~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*82~EB*W*IND*CQ~LS*2120~NM1*Y2*2*UNIVERSITY BEHAVIORAL ASSOCIATES IN*****XX*1760756852~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*MONTEFIORE MEDICAL CENTER*****XX*1831461847~LE*2120~EB*R*IND*30~REF*6P*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*7WE4MK5TC63~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*53*537570930~GE*1*537570930~IEA*1*537570930~