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271 Response
Eligibility Response Detail
CIN: TD08989J
Date of Service: July 26, 2026
Submitted: July 26, 2026 10:06 AM
Payload ID: 322355cb-337a-449b-bad3-3126bf34b6c8
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: July 1, 2026 — —
Plan: Medicare Coinsurance Deductible Only
MCO: —
Received: July 26, 2026 10:06 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Surplus | EB_COPAY | 0 | EB | EB08 | Surplus/co-payment amount $0 from EB segment |
Benefit Records (EB)
| EB01 | Service Type | Description | Amount | Period | Message |
|---|---|---|---|---|---|
| 1 | 30 | Medicare Coinsurance Deductible Only | — | — | |
| B | 30 | — | — | — | |
| 1 | 1 | — | — | — | |
| 1 | 33 | — | — | — | |
| 1 | 35 | — | — | — | |
| 1 | 47 | — | — | — | |
| 1 | 48 | — | — | — | |
| 1 | 50 | — | — | — | |
| 1 | 86 | — | — | — | |
| 1 | 88 | — | — | — | |
| 1 | 98 | — | — | — | |
| 1 | AL | — | — | — | |
| 1 | MH | — | — | — | |
| 1 | UC | — | — | — | |
| R | 30 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260726*1406*|*00501*074795253*1*P*:~GS*HS*00ND*EMEDNYREL*20260726*1406*795253*X*005010X279A1~ST*270*5253*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*TD08989J~EQ*30~DTP*291*D8*20260726~SE*13*5253~GE*1*795253~IEA*1*074795253~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260726*1006*^*00501*246628630*0*P*|~GS*HB*EMEDNYREL*00ND*20260726*100631*246628630*X*005010X279A1~ST*271*246628630*005010X279A1~BHT*0022*11*202607261406000001*20260726*100631~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*LEVY*YACOB****MI*TD08989J~N3*2224 EAST 63 RD STREET~N4*BROOKLYN*NY*11234~DMG*D8*19500321*M~DTP*472*D8*20260726~DTP*346*D8*20260701~DTP*102*D8*20251101~EB*1*IND*30**Medicare Coinsurance Deductible Only~MSG*60~MSG*S1~MSG*CNTY CD=66 5H9~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*33~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~EB*R*IND*30~REF*6P*H3312~LS*2120~NM1*P4*2*AETNA MEDICARE*****PI*H3312~N3*151 FARMINGTON AVENUE~N4*HARTFORD*CT*06156~PER*IC*PROVIDER SERVICES*TE*8002825366~LE*2120~EB*R*IND*30~REF*18*3FT5R17UE85~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*47*246628630~GE*1*246628630~IEA*1*246628630~