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271 Response
Eligibility Response Detail
CIN: ZV37475A
Date of Service: Sept. 14, 2026
Submitted: Sept. 14, 2026 7:17 AM
Payload ID: 2c40fee8-a848-47ba-8bc3-3dba4e43fe4f
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Sept. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: SOUTHWEST BROOKLYN HEALTH HOME LLC
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 | — | — | — | |
| W | CQ | — | — | — | |
| W | CQ | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260914*1117*|*00501*384661975*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1117*661975*X*005010X279A1~ST*270*1975*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*ZV37475A~EQ*30~DTP*291*D8*20260914~SE*13*1975~GE*1*661975~IEA*1*384661975~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260914*0717*^*00501*244013830*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071742*244013830*X*005010X279A1~ST*271*244013830*005010X279A1~BHT*0022*11*202609141117000001*20260914*071742~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*ASKEW*CHESTER****MI*ZV37475A~N3*185 ERASMUS ST E6~N4*BROOKLYN*NY*11226~DMG*D8*19630508*M~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260201~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*84~MSG*86~MSG*CNTY CD=66 508~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*W*IND*CQ~LS*2120~NM1*Y2*2*PUERTO RICAN FAMILY INST MH*****XX*1588873327~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*SOUTHWEST BROOKLYN HEALTH HOME LLC*****XX*1023354933~LE*2120~EB*R*IND*30~REF*6P*H3387~LS*2120~NM1*P4*2*UNITEDHEALTHCARE DUAL COMPLETE*****PI*H3387~N3*P O BOX 917~N4*NEW YORK*NY*10269~PER*IC*PROVIDER SERVICES*TE*8005144912~LE*2120~EB*R*IND*30~REF*18*6RT0XM0GU08~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*54*244013830~GE*1*244013830~IEA*1*244013830~