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271 Response
Eligibility Response Detail
CIN: ZA01940S
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:19 PM
Payload ID: d1ed026f-2d97-4377-bfe3-aad060ecb276
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
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-04-30 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| 1 | 30 | MA Eligible | — | — | |
| B | 30 | — | — | — | |
| 1 | 1 | — | — | — | |
| 1 | 4 | — | — | — | |
| 1 | 5 | — | — | — | |
| 1 | 35 | — | — | — | |
| 1 | 47 | — | — | — | |
| 1 | 48 | — | — | — | |
| 1 | 50 | — | — | — | |
| 1 | 86 | — | — | — | |
| 1 | 88 | — | — | — | |
| 1 | 98 | — | — | — | |
| 1 | AG | — | — | — | |
| 1 | AL | — | — | — | |
| 1 | MH | — | — | — | |
| 1 | UC | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1919*|*00501*648775109*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1919*775109*X*005010X279A1~ST*270*5109*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*ZA01940S~EQ*30~DTP*291*D8*20260814~SE*13*5109~GE*1*775109~IEA*1*648775109~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1519*^*00501*538251130*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151930*538251130*X*005010X279A1~ST*271*538251130*005010X279A1~BHT*0022*11*202608131919000001*20260813*151930~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*HOOKS*MARGARET****MI*ZA01940S~N3*18230 WEXFORD TERRACE 6A~N4*JAMAICA*NY*11432~DMG*D8*19480913*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20251001~EB*1*IND*30**MA Eligible~MSG*CNTY CD=66 525~MSG*RECERT MONTH=04~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~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*6P*H5989~LS*2120~NM1*P4*2*HEALTHFIRST SIGNATURE*****PI*H5989~N3*100 CHURCH STREET~N4*NEW YORK*NY*10007~PER*IC*PROVIDER SERVICES*TE*8557711081~LE*2120~EB*R*IND*30~REF*18*5GD2WA7GG06~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*48*538251130~GE*1*538251130~IEA*1*538251130~