Import ›
271 Response
Eligibility Response Detail
CIN: SS58072N
Date of Service: June 12, 2026
Submitted: July 28, 2026 11:00 AM
Payload ID: ea941f38-91db-49c7-a0e2-bb943affee41
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 11:00 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*1500*|*00501*250804628*1*P*:~GS*HS*00ND*EMEDNYREL*20260728*1500*804628*X*005010X279A1~ST*270*4628*005010X279A1~BHT*0022*13*202607281500000001*20260728*1500~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*202607281500000001*00000000ND~NM1*IL*1******MI*SS58072N~EQ*30~DTP*291*D8*20260612~SE*13*4628~GE*1*804628~IEA*1*250804628~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260728*1100*^*00501*364431130*0*P*|~GS*HB*EMEDNYREL*00ND*20260728*110001*364431130*X*005010X279A1~ST*271*364431130*005010X279A1~BHT*0022*11*202607281500000001*20260728*110001~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*202607281500000001*00000000ND~NM1*IL*1*BRAGINSKIY*TATYANA****MI*SS58072N~N3*40 BRIGHTON FIRST RD 11J~N4*BROOKLYN*NY*11235~DMG*D8*19590206*F~DTP*472*D8*20260728~DTP*346*D8*20260701~DTP*102*D8*20250801~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~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*H3312~LS*2120~NM1*P4*2*AETNA MEDICARE*****PI*H3312~N3*151 FARMINGTON AVENUE~N4*HARTFORD*CT*06156~PER*IC*PROVIDER SERVICES*TE*8002825366~LE*2120~EB*R*IND*30~REF*18*1R08C19MM30~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*364431130~GE*1*364431130~IEA*1*364431130~