Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1922*|*00501*648950506*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1922*950506*X*005010X279A1~ST*270*0506*005010X279A1~BHT*0022*13*202608131922000001*20260813*1922~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*202608131922000001*00000000ND~NM1*IL*1******MI*XQ94938N~EQ*30~DTP*291*D8*20260814~SE*13*0506~GE*1*950506~IEA*1*648950506~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1522*^*00501*541597330*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152226*541597330*X*005010X279A1~ST*271*541597330*005010X279A1~BHT*0022*11*202608131922000001*20260813*152226~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*202608131922000001*00000000ND~NM1*IL*1*JOLLY*BONNIE****MI*XQ94938N~N3*285 COZINE AVENUE             4-H~N4*BROOKLYN*NY*11207~DMG*D8*19530405*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*VILLAGE SENIOR SVC CORP PARTIAL LTC*****PI*VL~N3*112 CHARLES ST FL 2~N4*NEW YORK*NY*100142653~PER*IC*PROVIDER SERVICES*TE*8557692500~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H3387~LS*2120~NM1*P4*2*UNITEDHEALTHCARE DUAL COMPLETE*****PI*H3387~N3*P O BOX 917~N4*NEW YORK*NY*10269~PER*IC*PROVIDER SERVICES*TE*8005144912~LE*2120~EB*R*IND*30~REF*18*8DR8GN3XQ24~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*541597330~GE*1*541597330~IEA*1*541597330~