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271 Response
Eligibility Response Detail
CIN: SR22379Z
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:21 PM
Payload ID: aea777a8-bf84-4880-9dee-f59fce56d46b
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 3:21 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-02-28 | 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*1921*|*00501*648897240*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1921*897240*X*005010X279A1~ST*270*7240*005010X279A1~BHT*0022*13*202608131921000001*20260813*1921~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*202608131921000001*00000000ND~NM1*IL*1******MI*SR22379Z~EQ*30~DTP*291*D8*20260814~SE*13*7240~GE*1*897240~IEA*1*648897240~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1521*^*00501*541276330*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152132*541276330*X*005010X279A1~ST*271*541276330*005010X279A1~BHT*0022*11*202608131921000001*20260813*152132~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*202608131921000001*00000000ND~NM1*IL*1*GALLUCCIO*CHARLES****MI*SR22379Z~N3*61-35 DRY HARBOR ROAD~N4*MIDDLE VILLAGE*NY*11379~DMG*D8*19410207*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*NH~MSG*CNTY CD=66 588~MSG*RECERT MONTH=02~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*7MG5YK0WA64~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*36*541276330~GE*1*541276330~IEA*1*541276330~