Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1923*|*00501*648994601*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1923*994601*X*005010X279A1~ST*270*4601*005010X279A1~BHT*0022*13*202608131923000001*20260813*1923~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*202608131923000001*00000000ND~NM1*IL*1******MI*UU74293S~EQ*30~DTP*291*D8*20260814~SE*13*4601~GE*1*994601~IEA*1*648994601~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1523*^*00501*541786930*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152310*541786930*X*005010X279A1~ST*271*541786930*005010X279A1~BHT*0022*11*202608131923000001*20260813*152310~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*202608131923000001*00000000ND~NM1*IL*1*RODRIGUEZ*NANCY*A***MI*UU74293S~N3*135 ELMIRA LOOP               10G~N4*BROOKLYN*NY*11239~DMG*D8*19710108*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20251001~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*PD~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*W*IND*CQ~LS*2120~NM1*Y2*2*ESSEN MEDICAL ASSOCIATES PC*****XX*1366418709~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*MONTEFIORE MEDICAL CENTER*****XX*1831461847~LE*2120~SE*40*541786930~GE*1*541786930~IEA*1*541786930~