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271 Response
Eligibility Response Detail
CIN: SZ96869R
Date of Service: Sept. 14, 2026
Submitted: Sept. 14, 2026 7:17 AM
Payload ID: 76147d55-c291-4a2d-bbbc-7f56cad6ce6a
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Sept. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: VILLAGE SENIOR SVC CORP PARTIAL LTC
Received: Sept. 14, 2026 7:17 AM
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 | — | — | — | |
| 1 | 82 | — | — | — | |
| 1 | 88 | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260914*1117*|*00501*384636951*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1117*636951*X*005010X279A1~ST*270*6951*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*SZ96869R~EQ*30~DTP*291*D8*20260914~SE*13*6951~GE*1*636951~IEA*1*384636951~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260914*0717*^*00501*243979130*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071717*243979130*X*005010X279A1~ST*271*243979130*005010X279A1~BHT*0022*11*202609141117000001*20260914*071717~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*NIETO*ALICIA*O***MI*SZ96869R~N3*90-18 78 STREET 1~N4*WOODHAVEN*NY*11421~DMG*D8*19500906*F~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*VILLAGE SENIOR SVC CORP PARTIAL LTC*****PI*VL~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*1*IND*88~EB*R*IND*30~REF*6P*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*4U89HC9VC20~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*43*243979130~GE*1*243979130~IEA*1*243979130~