Import ›
271 Response
Eligibility Response Detail
CIN: RZ04374C
Date of Service: July 26, 2026
Submitted: July 26, 2026 10:06 AM
Payload ID: 5ebbd352-03bf-435d-bb68-cf0e5ee47375
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: July 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: ANTHEM HP LLC PARTIAL MLTC
Received: July 26, 2026 10:06 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Surplus | EB_COPAY | 0 | EB | EB08 | Surplus/co-payment amount $0 from EB segment |
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 *260726*1406*|*00501*074783826*1*P*:~GS*HS*00ND*EMEDNYREL*20260726*1406*783826*X*005010X279A1~ST*270*3826*005010X279A1~BHT*0022*13*202607261406000001*20260726*1406~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*202607261406000001*00000000ND~NM1*IL*1******MI*RZ04374C~EQ*30~DTP*291*D8*20260726~SE*13*3826~GE*1*783826~IEA*1*074783826~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260726*1006*^*00501*246612830*0*P*|~GS*HB*EMEDNYREL*00ND*20260726*100620*246612830*X*005010X279A1~ST*271*246612830*005010X279A1~BHT*0022*11*202607261406000001*20260726*100620~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*202607261406000001*00000000ND~NM1*IL*1*ALCANTARA*HUMBERTO****MI*RZ04374C~N3*301 E 143RD ST 1A~N4*BRONX*NY*10451~DMG*D8*19500823*M~DTP*472*D8*20260726~DTP*346*D8*20260701~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*ANTHEM HP LLC PARTIAL MLTC*****PI*KX~N3*ONE PENN PLZ FL 35~N4*NEW YORK*NY*101190000~PER*IC*PROVIDER SERVICES*TE*2125635570~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*1AT5AM4CQ84~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*41*246612830~GE*1*246612830~IEA*1*246612830~