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271 Response
Eligibility Response Detail
CIN: XB58178U
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:25 PM
Payload ID: b32b5e33-b46d-4e4e-b353-3d05a738eab8
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: MA Eligible
MCO: NEW YORK CITY HLTH & HOSP CORP
Received: Aug. 13, 2026 3:25 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-06-30 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| 1 | 30 | MA Eligible | — | — | |
| B | 30 | — | — | — | |
| 1 | 1 | — | — | — | |
| 1 | 4 | — | — | — | |
| 1 | 5 | — | — | — | |
| 1 | 35 | — | — | — | |
| 1 | 47 | — | — | — | |
| 1 | 48 | — | — | — | |
| 1 | 50 | — | — | — | |
| 1 | 86 | — | — | — | |
| 1 | 88 | — | — | — | |
| 1 | 98 | — | — | — | |
| 1 | AG | — | — | — | |
| 1 | AL | — | — | — | |
| 1 | MH | — | — | — | |
| 1 | UC | — | — | — | |
| Y | AG | — | $1458.00 | — | |
| Y | AG | — | $1458.00 | — | |
| W | CQ | — | — | — | |
| W | CQ | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1925*|*00501*649105455*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1925*105455*X*005010X279A1~ST*270*5455*005010X279A1~BHT*0022*13*202608131925000001*20260813*1925~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*202608131925000001*00000000ND~NM1*IL*1******MI*XB58178U~EQ*30~DTP*291*D8*20260814~SE*13*5455~GE*1*105455~IEA*1*649105455~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1525*^*00501*542247130*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152501*542247130*X*005010X279A1~ST*271*542247130*005010X279A1~BHT*0022*11*202608131925000001*20260813*152501~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*202608131925000001*00000000ND~NM1*IL*1*MORALES*RICARDO****MI*XB58178U~N3*2237 LINDEN BLVD~N4*BROOKLYN*NY*11207~DMG*D8*19601027*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260801~EB*1*IND*30**MA Eligible~MSG*A1~MSG*A2~MSG*PD~MSG*NH~MSG*CNTY CD=66 588~MSG*RECERT MONTH=06~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AG~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~EB*Y*IND*AG***29*1458~EB*Y*IND*AG***26*1458~DTP*291*D8*20260701~EB*W*IND*CQ~LS*2120~NM1*Y2*2*NATIONAL ASSOCIATION ON DRUG ABUSE*****XX*1295006526~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*NEW YORK CITY HLTH & HOSP CORP*****XX*1114558509~LE*2120~EB*R*IND*30~REF*18*5RK0R43RY06~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*55*542247130~GE*1*542247130~IEA*1*542247130~