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271 Response
Eligibility Response Detail
CIN: SD78834W
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:25 PM
Payload ID: 83f0d002-002d-44f3-8b48-187785597c98
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Aug. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: ANTHEM HP LLC PARTIAL MLTC
Received: Aug. 13, 2026 3:25 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2027-05-31 | 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 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1925*|*00501*649124478*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1925*124478*X*005010X279A1~ST*270*4478*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*SD78834W~EQ*30~DTP*291*D8*20260814~SE*13*4478~GE*1*124478~IEA*1*649124478~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1525*^*00501*542329930*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152520*542329930*X*005010X279A1~ST*271*542329930*005010X279A1~BHT*0022*11*202608131925000001*20260813*152520~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*MAKO*SAMIRA****MI*SD78834W~N3*159 RIEDEL AVENUE 2~N4*STATEN ISLAND*NY*10306~DMG*D8*19620228*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20251101~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=05~LS*2120~NM1*Y2*2*ANTHEM HP LLC PARTIAL MLTC*****PI*KX~N3*ONE PENN PLZ FL 35~N4*NEW YORK*NY*101190000~PER*IC*PROVIDER SERVICES*TE*2125635570~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~SE*30*542329930~GE*1*542329930~IEA*1*542329930~