Eligibility Response Detail

CIN: QK44450R

Date of Service: July 26, 2026

Submitted: July 26, 2026 10:06 AM

Payload ID: 68f67d6d-b7b4-493e-b4ba-43ac5994f6d2

Response Type: X12 271

Response Status: Ineligible

Member Found: Yes

Coverage: — — —

Plan: —

MCO: —

Received: July 26, 2026 10:06 AM

Parser Version: 1.0

Benefit Records (EB)

EB01	Service Type	Description	Amount	Period	Message
6	30	No Coverage - Excess Income, Resources Verified	—	—

Raw 270 Request

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260726*1406*|*00501*074794337*1*P*:~GS*HS*00ND*EMEDNYREL*20260726*1406*794337*X*005010X279A1~ST*270*4337*005010X279A1~BHT*0022*13*202607261406000001*20260726*1406~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*202607261406000001*00000000ND~NM1*IL*1******MI*QK44450R~EQ*30~DTP*291*D8*20260726~SE*13*4337~GE*1*794337~IEA*1*074794337~

Raw 271 Response

Full screen

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260726*1006*^*00501*246626930*0*P*|~GS*HB*EMEDNYREL*00ND*20260726*100630*246626930*X*005010X279A1~ST*271*246626930*005010X279A1~BHT*0022*11*202607261406000001*20260726*100630~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*202607261406000001*00000000ND~NM1*IL*1******MI*QK44450R~DTP*472*D8*20260726~EB*6*IND*30**No Coverage - Excess Income, Resources Verified~SE*13*246626930~GE*1*246626930~IEA*1*246626930~