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271 Response
Eligibility Response Detail
CIN: VA53321Y
Date of Service: June 12, 2026
Submitted: July 28, 2026 11:00 AM
Payload ID: 6b2bf92b-f3ff-4038-a5f5-8acb160c509a
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
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| S1 | S1 | S1 | MSG | MSG01 | S1 exemption code found in MSG segment |
| Recertification | RECERT | 2027-06-30 | 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 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260728*1500*|*00501*250830674*1*P*:~GS*HS*00ND*EMEDNYREL*20260728*1500*830674*X*005010X279A1~ST*270*0674*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*VA53321Y~EQ*30~DTP*291*D8*20260612~SE*13*0674~GE*1*830674~IEA*1*250830674~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260728*1100*^*00501*364577130*0*P*|~GS*HB*EMEDNYREL*00ND*20260728*110027*364577130*X*005010X279A1~ST*271*364577130*005010X279A1~BHT*0022*11*202607281500000001*20260728*110027~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*GOLUB*PETER****MI*VA53321Y~N3*10 CLINTON ST 11S~N4*BROOKLYN*NY*11201~DMG*D8*19460902*M~DTP*472*D8*20260728~DTP*346*D8*20260701~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=06~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*18*9WK8NE1TV33~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*36*364577130~GE*1*364577130~IEA*1*364577130~