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271 Response
Eligibility Response Detail
CIN: PX96762W
Date of Service: Aug. 14, 2026
Submitted: Aug. 13, 2026 3:26 PM
Payload ID: 18c5fea1-c4cd-4b00-a01c-58d4cc751144
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 3:26 PM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT | 2026-10-31 | MSG | Recertification required by this date |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| W | CQ | — | — | — | |
| W | CQ | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1926*|*00501*649173950*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1926*173950*X*005010X279A1~ST*270*3950*005010X279A1~BHT*0022*13*202608131926000001*20260813*1926~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*202608131926000001*00000000ND~NM1*IL*1******MI*PX96762W~EQ*30~DTP*291*D8*20260814~SE*13*3950~GE*1*173950~IEA*1*649173950~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1526*^*00501*542533730*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152609*542533730*X*005010X279A1~ST*271*542533730*005010X279A1~BHT*0022*11*202608131926000001*20260813*152609~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*202608131926000001*00000000ND~NM1*IL*1*SOW*HADYA****MI*PX96762W~N3*710 E 138TH ST 1~N4*BRONX*NY*10454~DMG*D8*19640101*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*PD~MSG*CNTY CD=66 523~MSG*RECERT MONTH=10~EB*B*IND*30***29*0~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*SRH CHN LEAD HEALTH HOME LLC*****XX*1750053948~LE*2120~EB*R*IND*30~REF*6P*H0423~LS*2120~NM1*P4*2*METROPLUS HEALTH PLAN, INC.*****PI*H0423~N3*160 WATER STREET~N4*NEW YORK*NY*10038~PER*IC*PROVIDER SERVICES*TE*8669860356~LE*2120~EB*R*IND*30~REF*18*9WV9RD3MR18~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*46*542533730~GE*1*542533730~IEA*1*542533730~