Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1926*|*00501*649175951*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1926*175951*X*005010X279A1~ST*270*5951*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*ZV64071S~EQ*30~DTP*291*D8*20260814~SE*13*5951~GE*1*175951~IEA*1*649175951~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1526*^*00501*542543230*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152611*542543230*X*005010X279A1~ST*271*542543230*005010X279A1~BHT*0022*11*202608131926000001*20260813*152611~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*JONES*ELIZABETH*A***MI*ZV64071S~N3*P O BOX 808~N4*NEW YORK*NY*10276~DMG*D8*19570319*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*H9~MSG*PD~MSG*CNTY CD=66 523~LS*2120~NM1*Y2*2*VILLAGE SENIOR SERVICES CORP MAP*****PI*VM~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*W*IND*CQ~LS*2120~NM1*Y2*2*ASSOC/REHAB CASE MGNT HOU  MH*****XX*1649420092~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*COORDINATED BEHAVIORAL CARE INC*****XX*1730451071~LE*2120~EB*R*IND*30~REF*6P*H2168~LS*2120~NM1*P4*2*VILLAGECAREMAX MEDICARE TOTAL ADVAN*****PI*H2168~N3*P O  BOX 5426~N4*HAUPPAUGE*NY*117885426~PER*IC*PROVIDER SERVICES*TE*8004696292~LE*2120~EB*R*IND*30~REF*18*1AG7KV9MM33~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*53*542543230~GE*1*542543230~IEA*1*542543230~