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271 Response
Eligibility Response Detail
CIN: XR51235B
Date of Service: Sept. 14, 2026
Submitted: Sept. 14, 2026 7:17 AM
Payload ID: 2106459b-e926-4176-b2a0-4d7d95db88b5
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Sept. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: VILLAGE SENIOR SERVICES CORP MAP
Received: Sept. 14, 2026 7:17 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| S1 | S1 | S1 | MSG | MSG01 | S1 exemption code found in MSG segment |
| 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 | — | — | — | |
| 1 | 82 | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260914*1117*|*00501*384635950*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1117*635950*X*005010X279A1~ST*270*5950*005010X279A1~BHT*0022*13*202609141117000001*20260914*1117~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*202609141117000001*00000000ND~NM1*IL*1******MI*XR51235B~EQ*30~DTP*291*D8*20260914~SE*13*5950~GE*1*635950~IEA*1*384635950~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260914*0717*^*00501*243977430*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071716*243977430*X*005010X279A1~ST*271*243977430*005010X279A1~BHT*0022*11*202609141117000001*20260914*071716~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*202609141117000001*00000000ND~NM1*IL*1*ALVIRA*ALEJANDRO****MI*XR51235B~N3*143 HIMROD STREET 2B~N4*BROOKLYN*NY*11221~DMG*D8*19350227*M~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~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*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*3EF8J68TY52~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*243977430~GE*1*243977430~IEA*1*243977430~