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271 Response
Eligibility Response Detail
CIN: YZ52885Q
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:19 PM
Payload ID: 0fea17a2-e576-4a87-b6cd-42cbee861d5b
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: MA Eligible
MCO: —
Received: Aug. 13, 2026 3:19 PM
Parser Version: 1.0
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| 1 | 30 | MA Eligible | — | — | |
| B | 30 | — | — | — | |
| 1 | 1 | — | — | — | |
| 1 | 4 | — | — | — | |
| 1 | 5 | — | — | — | |
| 1 | 33 | — | — | — | |
| 1 | 35 | — | — | — | |
| 1 | 47 | — | — | — | |
| 1 | 48 | — | — | — | |
| 1 | 50 | — | — | — | |
| 1 | 86 | — | — | — | |
| 1 | 88 | — | — | — | |
| 1 | 98 | — | — | — | |
| 1 | AG | — | — | — | |
| 1 | AL | — | — | — | |
| 1 | MH | — | — | — | |
| 1 | UC | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1919*|*00501*648747074*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1919*747074*X*005010X279A1~ST*270*7074*005010X279A1~BHT*0022*13*202608131919000001*20260813*1919~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*202608131919000001*00000000ND~NM1*IL*1******MI*YZ52885Q~EQ*30~DTP*291*D8*20260814~SE*13*7074~GE*1*747074~IEA*1*648747074~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1519*^*00501*538109330*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151902*538109330*X*005010X279A1~ST*271*538109330*005010X279A1~BHT*0022*11*202608131919000001*20260813*151902~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*202608131919000001*00000000ND~NM1*IL*1*DEKTYAREV*MARIA****MI*YZ52885Q~N3*868 EAST 7TH STREET 6H~N4*BKLYN*NY*11230~DMG*D8*19380202*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*1*IND*30**MA Eligible~MSG*PD~MSG*CNTY CD=66 5H9~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*33~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AG~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~EB*R*IND*30~REF*18*2EM8NN1VG23~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*41*538109330~GE*1*538109330~IEA*1*538109330~