Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260728*1500*|*00501*250848689*1*P*:~GS*HS*00ND*EMEDNYREL*20260728*1500*848689*X*005010X279A1~ST*270*8689*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*UA32852R~EQ*30~DTP*291*D8*20260612~SE*13*8689~GE*1*848689~IEA*1*250848689~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260728*1100*^*00501*364690230*0*P*|~GS*HB*EMEDNYREL*00ND*20260728*110045*364690230*X*005010X279A1~ST*271*364690230*005010X279A1~BHT*0022*11*202607281500000001*20260728*110045~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*JONES*WILLIAM****MI*UA32852R~N3*261 BUFFALO AVE               4I~N4*BROOKLYN*NY*11213~DMG*D8*19460530*M~DTP*472*D8*20260728~DTP*346*D8*20260701~DTP*102*D8*20260301~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*H8432~LS*2120~NM1*P4*2*EMPIRE MEDIBLUE CORE*****PI*H8432~N3*EMPIRE MEDIBLUE*PO BOX 1407 CHURCH STREET STATION~N4*NEW YORK*NY*100081407~PER*IC*PROVIDER SERVICES*TE*8557311090~LE*2120~EB*R*IND*30~REF*18*7XM7MD0TJ55~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*364690230~GE*1*364690230~IEA*1*364690230~