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271 Response
Eligibility Response Detail
CIN: UH91058U
Date of Service: July 26, 2026
Submitted: July 26, 2026 10:06 AM
Payload ID: 041c8d01-9a53-4dc6-a246-0ce0d70ca5c4
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: July 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: ANTHEM HP LLC PARTIAL MLTC
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 |
|---|---|---|---|---|---|
| U | 30 | ELIGIBLE PCP | — | — | |
| B | 30 | — | — | — | |
| 1 | 82 | — | — | — | |
| 1 | 88 | — | — | — | |
| R | 30 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260726*1406*|*00501*074798688*1*P*:~GS*HS*00ND*EMEDNYREL*20260726*1406*798688*X*005010X279A1~ST*270*8688*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*UH91058U~EQ*30~DTP*291*D8*20260726~SE*13*8688~GE*1*798688~IEA*1*074798688~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260726*1006*^*00501*246633930*0*P*|~GS*HB*EMEDNYREL*00ND*20260726*100635*246633930*X*005010X279A1~ST*271*246633930*005010X279A1~BHT*0022*11*202607261406000001*20260726*100635~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*MOSTOVAYA*YELIZAVETA****MI*UH91058U~N3*0-79 27TH ST~N4*FAIR LAWN*NJ*07410~DMG*D8*19380301*F~DTP*472*D8*20260726~DTP*346*D8*20260701~DTP*102*D8*20251201~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*18*2E06HT0KV45~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*34*246633930~GE*1*246633930~IEA*1*246633930~