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271 Response
Eligibility Response Detail
CIN: ZZ79195R
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:23 PM
Payload ID: ca39655e-ab1e-4480-8f78-49e9705d6cdd
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: SRH CHN LEAD HEALTH HOME LLC
Received: Aug. 13, 2026 3:23 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-07-31 | 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 | — | — | — | |
| W | CQ | — | — | — | |
| W | CQ | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1923*|*00501*648998607*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1923*998607*X*005010X279A1~ST*270*8607*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*ZZ79195R~EQ*30~DTP*291*D8*20260814~SE*13*8607~GE*1*998607~IEA*1*648998607~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1523*^*00501*541805630*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152314*541805630*X*005010X279A1~ST*271*541805630*005010X279A1~BHT*0022*11*202608131923000001*20260813*152314~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*ROSA*MARIA*C***MI*ZZ79195R~N3*22 MOFFAT ST 6C~N4*BROOKLYN*NY*11207~DMG*D8*19470723*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260601~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=07~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*COMMUNITY HLTHCARE NETWORK AI*****XX*1952518078~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*SRH CHN LEAD HEALTH HOME LLC*****XX*1750053948~LE*2120~EB*R*IND*30~REF*18*7V39YP1AH47~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*46*541805630~GE*1*541805630~IEA*1*541805630~