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271 Response
Eligibility Response Detail
CIN: QH49075H
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:20 PM
Payload ID: ffce55f8-0879-4dd8-9764-482986515559
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: SENIOR WHOLE HEALTH OF NY PARTIAL
Received: Aug. 13, 2026 3:20 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-03-31 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| 1 | 88 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1920*|*00501*648812149*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1920*812149*X*005010X279A1~ST*270*2149*005010X279A1~BHT*0022*13*202608131920000001*20260813*1920~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*202608131920000001*00000000ND~NM1*IL*1******MI*QH49075H~EQ*30~DTP*291*D8*20260814~SE*13*2149~GE*1*812149~IEA*1*648812149~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1520*^*00501*538413130*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152007*538413130*X*005010X279A1~ST*271*538413130*005010X279A1~BHT*0022*11*202608131920000001*20260813*152007~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*202608131920000001*00000000ND~NM1*IL*1*BARSHACK*GALINA****MI*QH49075H~N3*3015 W29TH ST~N4*BROOKLYN*NY*11224~DMG*D8*19461001*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260201~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=03~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*8NK9GN9WM36~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*36*538413130~GE*1*538413130~IEA*1*538413130~