Eligibility Response Detail

Benefit Records (EB)

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260728*1500*|*00501*250852693*1*P*:~GS*HS*00ND*EMEDNYREL*20260728*1500*852693*X*005010X279A1~ST*270*2693*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*WD75982R~EQ*30~DTP*291*D8*20260612~SE*13*2693~GE*1*852693~IEA*1*250852693~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260728*1100*^*00501*364712730*0*P*|~GS*HB*EMEDNYREL*00ND*20260728*110049*364712730*X*005010X279A1~ST*271*364712730*005010X279A1~BHT*0022*11*202607281500000001*20260728*110049~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*KURMAN*FANYA****MI*WD75982R~N3*20 OCEAN CT                   5J~N4*BROOKLYN*NY*11223~DMG*D8*19360804*F~DTP*472*D8*20260728~DTP*346*D8*20260701~DTP*102*D8*20251001~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~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*18*9K94RN6CX66~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*35*364712730~GE*1*364712730~IEA*1*364712730~