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271 Response
Eligibility Response Detail
CIN: ZD22733M
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:19 PM
Payload ID: e9ea9048-e03b-4a14-ab99-356214f2b0e6
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 |
|---|---|---|---|---|---|
| Code 60 | 60 | 60 | MSG | MSG01 | Code 60 found in MSG segment |
| 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*648787121*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1919*787121*X*005010X279A1~ST*270*7121*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*ZD22733M~EQ*30~DTP*291*D8*20260814~SE*13*7121~GE*1*787121~IEA*1*648787121~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1519*^*00501*538311230*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151942*538311230*X*005010X279A1~ST*271*538311230*005010X279A1~BHT*0022*11*202608131919000001*20260813*151942~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*QUINONES*CARMEN****MI*ZD22733M~N3*3135 PARK AVE 20A~N4*BRONX*NY*10454~DMG*D8*19370727*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*1*IND*30**MA Eligible~MSG*PD~MSG*60~MSG*CNTY CD=66 523~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*18*093287042~REF*6P*0~LS*2120~NM1*P4*2*VISION SERVICE PLAN (VSP)*****PI*VSP~N3*PO BOX 997105~N4*SACRAMENTO*CA*958897105~PER*IC*PROVIDER SERVICES*TE*8008777195~LE*2120~EB*R*IND*30~REF*18*3H97EE4QV34~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*51*538311230~GE*1*538311230~IEA*1*538311230~