Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260728*1500*|*00501*250845686*1*P*:~GS*HS*00ND*EMEDNYREL*20260728*1500*845686*X*005010X279A1~ST*270*5686*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*XS84280Q~EQ*30~DTP*291*D8*20260612~SE*13*5686~GE*1*845686~IEA*1*250845686~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260728*1100*^*00501*364672130*0*P*|~GS*HB*EMEDNYREL*00ND*20260728*110042*364672130*X*005010X279A1~ST*271*364672130*005010X279A1~BHT*0022*11*202607281500000001*20260728*110042~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*JIMENEZ*RAMONA*C***MI*XS84280Q~N3*1719 CORNELIA ST              1R~N4*RIDGEWOOD*NY*11385~DMG*D8*19561120*F~DTP*472*D8*20260728~DTP*346*D8*20260701~DTP*102*D8*20250901~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*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*6HC6KM8NX40~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*364672130~GE*1*364672130~IEA*1*364672130~