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271 Response
Eligibility Response Detail
CIN: RZ04374C
Date of Service: June 12, 2026
Submitted: July 28, 2026 10:59 AM
Payload ID: 3ac31654-d37e-499c-9e4d-003b2d8fe9c2
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 28, 2026 10:59 AM
Parser Version: 1.0
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 *260728*1459*|*00501*250790630*1*P*:~GS*HS*00ND*EMEDNYREL*20260728*1459*790630*X*005010X279A1~ST*270*0630*005010X279A1~BHT*0022*13*202607281459000001*20260728*1459~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*202607281459000001*00000000ND~NM1*IL*1******MI*RZ04374C~EQ*30~DTP*291*D8*20260612~SE*13*0630~GE*1*790630~IEA*1*250790630~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260728*1059*^*00501*364364230*0*P*|~GS*HB*EMEDNYREL*00ND*20260728*105947*364364230*X*005010X279A1~ST*271*364364230*005010X279A1~BHT*0022*11*202607281459000001*20260728*105947~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*202607281459000001*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*20260728~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*364364230~GE*1*364364230~IEA*1*364364230~