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271 Response
Eligibility Response Detail
CIN: YQ57727J
Date of Service: Sept. 14, 2026
Submitted: Sept. 14, 2026 7:20 AM
Payload ID: f576a761-0f47-4332-855f-ffcfb6808fb8
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: Sept. 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: SRH CHN LEAD HEALTH HOME LLC
Received: Sept. 14, 2026 7:20 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 | — | — | — | |
| W | CQ | — | — | — | |
| W | CQ | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260914*1120*|*00501*384815031*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1120*815031*X*005010X279A1~ST*270*5031*005010X279A1~BHT*0022*13*202609141120000001*20260914*1120~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*202609141120000001*00000000ND~NM1*IL*1******MI*YQ57727J~EQ*30~DTP*291*D8*20260914~SE*13*5031~GE*1*815031~IEA*1*384815031~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260914*0720*^*00501*244322230*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*072015*244322230*X*005010X279A1~ST*271*244322230*005010X279A1~BHT*0022*11*202609141120000001*20260914*072015~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*202609141120000001*00000000ND~NM1*IL*1*REYES*RAFAEL****MI*YQ57727J~N3*2865 KINGSBRIDGE TERRRACE 5L~N4*BRONX*NY*10463~DMG*D8*19780415*M~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260201~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*PD~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*ELDERPLAN INC MAP*****PI*YL~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8778916447~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*W*IND*CQ~LS*2120~NM1*Y2*2*METRO CARE MANAGEMENT LLC*****XX*1922565118~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*H3347~LS*2120~NM1*P4*2*ELDERPLAN*****PI*H3347~N3*ELDERPLAN INC 745 64TH STREET~N4*BROOKLYN*NY*11220~PER*IC*PROVIDER SERVICES*TE*8003533765~LE*2120~EB*R*IND*30~REF*18*4WQ3K49YW08~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*54*244322230~GE*1*244322230~IEA*1*244322230~