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271 Response
Eligibility Response Detail
CIN: ZR98837F
Date of Service: July 26, 2026
Submitted: July 26, 2026 10:09 AM
Payload ID: 2353a9a4-f494-48ba-840f-4599233d448c
Response Type: X12 271
Response Status:
Eligible
Member Found: Yes
Coverage: July 1, 2026 — —
Plan: ELIGIBLE PCP
MCO: FIDELIS CARE MAINSTREAM
Received: July 26, 2026 10:09 AM
Parser Version: 1.0
Eligibility Indicators
| Type | Code | Value | Segment | Element | Description |
|---|---|---|---|---|---|
| Recertification | RECERT_MONTH | 12 | MSG | MSG01 | Recertification month: 12 |
| 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 | 88 | — | — | — |
Raw 270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260726*1409*|*00501*074940086*1*P*:~GS*HS*00ND*EMEDNYREL*20260726*1409*940086*X*005010X279A1~ST*270*0086*005010X279A1~BHT*0022*13*202607261409000001*20260726*1409~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*202607261409000001*00000000ND~NM1*IL*1******MI*ZR98837F~EQ*30~DTP*291*D8*20260726~SE*13*0086~GE*1*940086~IEA*1*074940086~
Raw 271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260726*1008*^*00501*246768530*0*P*|~GS*HB*EMEDNYREL*00ND*20260726*100856*246768530*X*005010X279A1~ST*271*246768530*005010X279A1~BHT*0022*11*202607261409000001*20260726*100856~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*202607261409000001*00000000ND~NM1*IL*1*MILLER*SAMANTHA****MI*ZR98837F~N3*1155 229TH DR S APT 3D~N4*BRONX*NY*10466~DMG*D8*19820315*F~DTP*472*D8*20260726~DTP*346*D8*20260701~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 H78~MSG*RECERT MONTH=12~LS*2120~NM1*Y2*2*FIDELIS CARE MAINSTREAM*****PI*SP~N3*25-01 JACKSON AVE~N4*LONG ISLAND CITY*NY*111015095~PER*IC*PROVIDER SERVICES*TE*7188966500~LE*2120~EB*B*IND*30***29*0~EB*1*IND*88~SE*30*246768530~GE*1*246768530~IEA*1*246768530~