GET api/Enrollment/CheckEligibility?HICNumber={HICNumber}&LastName={LastName}&BirthDate={BirthDate}

Request Information

URI Parameters

Name	Type	Additional information
HICNumber	string	Required
LastName	string	Required
BirthDate	string	None.

Body Parameters

None.

Request Formats

text/json, application/json

Sample:

Request sample for request 

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{
  "HICNumber": "sample string 1",
  "LastName": "sample string 2",
  "BirthDate": "sample string 3"
}

--------------------------------------------------------------------------------------------------------------------------------

text/xml, application/xml

Sample:

Request sample for request 

--------------------------------------------------------------------------------------------------------------------------------

<InfocrossingRequest xmlns="http://schemas.datacontract.org/2004/07/AHC.WebServices.WebAPI.DTOs" xmlns:i="http://www.w3.org/2001/XMLSchema-instance">
  <BirthDate>sample string 3</BirthDate>
  <HICNumber>sample string 1</HICNumber>
  <LastName>sample string 2</LastName>
</InfocrossingRequest>

--------------------------------------------------------------------------------------------------------------------------------

Response Information

Resource Description

IHttpActionResult

None.

Response Formats

text/json, application/json

Sample:


--------------------------------------------------------------------------------------------------------------------------------

[
  {
    "TransactionDate": "sample string 1",
    "mbdLoadEffDate": "sample string 2",
    "RequestHicNbr": "sample string 3",
    "RequestMedID": "sample string 4",
    "RequestLastName": "sample string 5",
    "RequestDOB": "sample string 6",
    "FoundHICNNumber": "sample string 7",
    "FoundMedID": "sample string 8",
    "FoundNameOrDOB": "sample string 9",
    "InquiryResponse": "sample string 10",
    "HICNNumber": "sample string 11",
    "MedID": "sample string 12",
    "LastName": "sample string 13",
    "FirstName": "sample string 14",
    "MiddleInitial": "sample string 15",
    "GenderCd": "sample string 16",
    "RaceCd": "sample string 17",
    "BirthDate": "sample string 18",
    "PartAEntitlementDate": "sample string 19",
    "PartAEntitleEndDate": "sample string 20",
    "PartBEntitlementDate": "sample string 21",
    "PartBEntitleEndDate": "sample string 22",
    "StateCd": "sample string 23",
    "CountyCd": "sample string 24",
    "HospiceStatus": "sample string 25",
    "HospiceStartDate": "sample string 26",
    "HospiceEndDate": "sample string 27",
    "InstitutionalizedStatus": "sample string 28",
    "InstitutionalizedStartDate": "sample string 29",
    "InstitutionalizedEndDate": "sample string 30",
    "ESRDStatus": "sample string 31",
    "ESRDStartDate": "sample string 32",
    "ESRDEndDate": "sample string 33",
    "MedicaidStatus": "sample string 34",
    "MedicaidStartDate": "sample string 35",
    "MedicaidEndDate": "sample string 36",
    "LivingStatus": "sample string 37",
    "DeathDate": "sample string 38",
    "XrefHicnNumber": "sample string 39",
    "EnrollmentInfo": [
      {
        "PlanIdField": "sample string 1",
        "PBPField": "sample string 2",
        "EGHPField": "sample string 3",
        "PlanTypeCodeField": "sample string 4",
        "PlanEnrollmentDateField": "sample string 5",
        "DrugPlanIndField": "sample string 6",
        "EnrollSourceCode": "sample string 7"
      },
      {
        "PlanIdField": "sample string 1",
        "PBPField": "sample string 2",
        "EGHPField": "sample string 3",
        "PlanTypeCodeField": "sample string 4",
        "PlanEnrollmentDateField": "sample string 5",
        "DrugPlanIndField": "sample string 6",
        "EnrollSourceCode": "sample string 7"
      }
    ],
    "PotentialUncvrdMths": "sample string 40",
    "PotentialUncvrdMthsEffDate": "sample string 41",
    "PartDEligibleDate": "sample string 42",
    "ListInfo": [
      {
        "SubsidyStartDateField": "sample string 1",
        "SubsidyEndDateField": "sample string 2",
        "CopayLevelField": "sample string 3",
        "PartDPremSubPctField": "sample string 4"
      },
      {
        "SubsidyStartDateField": "sample string 1",
        "SubsidyEndDateField": "sample string 2",
        "CopayLevelField": "sample string 3",
        "PartDPremSubPctField": "sample string 4"
      }
    ],
    "PartDHistoryInfo": [
      {
        "PartDStartDateField": "sample string 1",
        "PartDEndDateField": "sample string 2"
      },
      {
        "PartDStartDateField": "sample string 1",
        "PartDEndDateField": "sample string 2"
      }
    ],
    "NuncMoInfo": [
      {
        "UncovMthsStartDateField": "sample string 1",
        "UncovMthsField": "sample string 2",
        "UncmoIndField": "sample string 3",
        "TotUncovMthsField": "sample string 4"
      },
      {
        "UncovMthsStartDateField": "sample string 1",
        "UncovMthsField": "sample string 2",
        "UncmoIndField": "sample string 3",
        "TotUncovMthsField": "sample string 4"
      }
    ],
    "RDSHistoryInfo": [
      {
        "RDSStartDateField": "sample string 1",
        "RDSEndDateField": "sample string 2"
      },
      {
        "RDSStartDateField": "sample string 1",
        "RDSEndDateField": "sample string 2"
      }
    ],
    "MedicareInEligibilityInfo": [
      {
        "MedicareIneligibilityStartDateField": "sample string 1",
        "MedicareIneligibilityEndDateField": "sample string 2"
      },
      {
        "MedicareIneligibilityStartDateField": "sample string 1",
        "MedicareIneligibilityEndDateField": "sample string 2"
      }
    ],
    "PriorEnrollmentInfo": [
      {
        "PriorPlanIdField": "sample string 1",
        "PriorPBPField": "sample string 2",
        "PriorEGHPField": "sample string 3",
        "PriorPlanTypeCodeField": "sample string 4",
        "PriorPlanEnrollmentDateField": "sample string 5",
        "priorPlanEnrollmentEndDate": "sample string 6",
        "PriorDrugPlanIndField": "sample string 7",
        "PriorEnrollSourceCode": "sample string 8"
      },
      {
        "PriorPlanIdField": "sample string 1",
        "PriorPBPField": "sample string 2",
        "PriorEGHPField": "sample string 3",
        "PriorPlanTypeCodeField": "sample string 4",
        "PriorPlanEnrollmentDateField": "sample string 5",
        "priorPlanEnrollmentEndDate": "sample string 6",
        "PriorDrugPlanIndField": "sample string 7",
        "PriorEnrollSourceCode": "sample string 8"
      }
    ]
  },
  {
    "TransactionDate": "sample string 1",
    "mbdLoadEffDate": "sample string 2",
    "RequestHicNbr": "sample string 3",
    "RequestMedID": "sample string 4",
    "RequestLastName": "sample string 5",
    "RequestDOB": "sample string 6",
    "FoundHICNNumber": "sample string 7",
    "FoundMedID": "sample string 8",
    "FoundNameOrDOB": "sample string 9",
    "InquiryResponse": "sample string 10",
    "HICNNumber": "sample string 11",
    "MedID": "sample string 12",
    "LastName": "sample string 13",
    "FirstName": "sample string 14",
    "MiddleInitial": "sample string 15",
    "GenderCd": "sample string 16",
    "RaceCd": "sample string 17",
    "BirthDate": "sample string 18",
    "PartAEntitlementDate": "sample string 19",
    "PartAEntitleEndDate": "sample string 20",
    "PartBEntitlementDate": "sample string 21",
    "PartBEntitleEndDate": "sample string 22",
    "StateCd": "sample string 23",
    "CountyCd": "sample string 24",
    "HospiceStatus": "sample string 25",
    "HospiceStartDate": "sample string 26",
    "HospiceEndDate": "sample string 27",
    "InstitutionalizedStatus": "sample string 28",
    "InstitutionalizedStartDate": "sample string 29",
    "InstitutionalizedEndDate": "sample string 30",
    "ESRDStatus": "sample string 31",
    "ESRDStartDate": "sample string 32",
    "ESRDEndDate": "sample string 33",
    "MedicaidStatus": "sample string 34",
    "MedicaidStartDate": "sample string 35",
    "MedicaidEndDate": "sample string 36",
    "LivingStatus": "sample string 37",
    "DeathDate": "sample string 38",
    "XrefHicnNumber": "sample string 39",
    "EnrollmentInfo": [
      {
        "PlanIdField": "sample string 1",
        "PBPField": "sample string 2",
        "EGHPField": "sample string 3",
        "PlanTypeCodeField": "sample string 4",
        "PlanEnrollmentDateField": "sample string 5",
        "DrugPlanIndField": "sample string 6",
        "EnrollSourceCode": "sample string 7"
      },
      {
        "PlanIdField": "sample string 1",
        "PBPField": "sample string 2",
        "EGHPField": "sample string 3",
        "PlanTypeCodeField": "sample string 4",
        "PlanEnrollmentDateField": "sample string 5",
        "DrugPlanIndField": "sample string 6",
        "EnrollSourceCode": "sample string 7"
      }
    ],
    "PotentialUncvrdMths": "sample string 40",
    "PotentialUncvrdMthsEffDate": "sample string 41",
    "PartDEligibleDate": "sample string 42",
    "ListInfo": [
      {
        "SubsidyStartDateField": "sample string 1",
        "SubsidyEndDateField": "sample string 2",
        "CopayLevelField": "sample string 3",
        "PartDPremSubPctField": "sample string 4"
      },
      {
        "SubsidyStartDateField": "sample string 1",
        "SubsidyEndDateField": "sample string 2",
        "CopayLevelField": "sample string 3",
        "PartDPremSubPctField": "sample string 4"
      }
    ],
    "PartDHistoryInfo": [
      {
        "PartDStartDateField": "sample string 1",
        "PartDEndDateField": "sample string 2"
      },
      {
        "PartDStartDateField": "sample string 1",
        "PartDEndDateField": "sample string 2"
      }
    ],
    "NuncMoInfo": [
      {
        "UncovMthsStartDateField": "sample string 1",
        "UncovMthsField": "sample string 2",
        "UncmoIndField": "sample string 3",
        "TotUncovMthsField": "sample string 4"
      },
      {
        "UncovMthsStartDateField": "sample string 1",
        "UncovMthsField": "sample string 2",
        "UncmoIndField": "sample string 3",
        "TotUncovMthsField": "sample string 4"
      }
    ],
    "RDSHistoryInfo": [
      {
        "RDSStartDateField": "sample string 1",
        "RDSEndDateField": "sample string 2"
      },
      {
        "RDSStartDateField": "sample string 1",
        "RDSEndDateField": "sample string 2"
      }
    ],
    "MedicareInEligibilityInfo": [
      {
        "MedicareIneligibilityStartDateField": "sample string 1",
        "MedicareIneligibilityEndDateField": "sample string 2"
      },
      {
        "MedicareIneligibilityStartDateField": "sample string 1",
        "MedicareIneligibilityEndDateField": "sample string 2"
      }
    ],
    "PriorEnrollmentInfo": [
      {
        "PriorPlanIdField": "sample string 1",
        "PriorPBPField": "sample string 2",
        "PriorEGHPField": "sample string 3",
        "PriorPlanTypeCodeField": "sample string 4",
        "PriorPlanEnrollmentDateField": "sample string 5",
        "priorPlanEnrollmentEndDate": "sample string 6",
        "PriorDrugPlanIndField": "sample string 7",
        "PriorEnrollSourceCode": "sample string 8"
      },
      {
        "PriorPlanIdField": "sample string 1",
        "PriorPBPField": "sample string 2",
        "PriorEGHPField": "sample string 3",
        "PriorPlanTypeCodeField": "sample string 4",
        "PriorPlanEnrollmentDateField": "sample string 5",
        "priorPlanEnrollmentEndDate": "sample string 6",
        "PriorDrugPlanIndField": "sample string 7",
        "PriorEnrollSourceCode": "sample string 8"
      }
    ]
  }
]

--------------------------------------------------------------------------------------------------------------------------------

text/xml, application/xml

Sample:


--------------------------------------------------------------------------------------------------------------------------------

<ArrayOfEligibilityResponse xmlns="http://schemas.datacontract.org/2004/07/AHC.WebServices.WebAPI.DTOs" xmlns:i="http://www.w3.org/2001/XMLSchema-instance">
  <EligibilityResponse>
    <BirthDate>sample string 18</BirthDate>
    <CountyCd>sample string 24</CountyCd>
    <DeathDate>sample string 38</DeathDate>
    <ESRDEndDate>sample string 33</ESRDEndDate>
    <ESRDStartDate>sample string 32</ESRDStartDate>
    <ESRDStatus>sample string 31</ESRDStatus>
    <EnrollmentInfo>
      <CMSEnrollmentData>
        <DrugPlanIndField>sample string 6</DrugPlanIndField>
        <EGHPField>sample string 3</EGHPField>
        <EnrollSourceCode>sample string 7</EnrollSourceCode>
        <PBPField>sample string 2</PBPField>
        <PlanEnrollmentDateField>sample string 5</PlanEnrollmentDateField>
        <PlanIdField>sample string 1</PlanIdField>
        <PlanTypeCodeField>sample string 4</PlanTypeCodeField>
      </CMSEnrollmentData>
      <CMSEnrollmentData>
        <DrugPlanIndField>sample string 6</DrugPlanIndField>
        <EGHPField>sample string 3</EGHPField>
        <EnrollSourceCode>sample string 7</EnrollSourceCode>
        <PBPField>sample string 2</PBPField>
        <PlanEnrollmentDateField>sample string 5</PlanEnrollmentDateField>
        <PlanIdField>sample string 1</PlanIdField>
        <PlanTypeCodeField>sample string 4</PlanTypeCodeField>
      </CMSEnrollmentData>
    </EnrollmentInfo>
    <FirstName>sample string 14</FirstName>
    <FoundHICNNumber>sample string 7</FoundHICNNumber>
    <FoundMedID>sample string 8</FoundMedID>
    <FoundNameOrDOB>sample string 9</FoundNameOrDOB>
    <GenderCd>sample string 16</GenderCd>
    <HICNNumber>sample string 11</HICNNumber>
    <HospiceEndDate>sample string 27</HospiceEndDate>
    <HospiceStartDate>sample string 26</HospiceStartDate>
    <HospiceStatus>sample string 25</HospiceStatus>
    <InquiryResponse>sample string 10</InquiryResponse>
    <InstitutionalizedEndDate>sample string 30</InstitutionalizedEndDate>
    <InstitutionalizedStartDate>sample string 29</InstitutionalizedStartDate>
    <InstitutionalizedStatus>sample string 28</InstitutionalizedStatus>
    <LastName>sample string 13</LastName>
    <ListInfo>
      <CMSLisData>
        <CopayLevelField>sample string 3</CopayLevelField>
        <PartDPremSubPctField>sample string 4</PartDPremSubPctField>
        <SubsidyEndDateField>sample string 2</SubsidyEndDateField>
        <SubsidyStartDateField>sample string 1</SubsidyStartDateField>
      </CMSLisData>
      <CMSLisData>
        <CopayLevelField>sample string 3</CopayLevelField>
        <PartDPremSubPctField>sample string 4</PartDPremSubPctField>
        <SubsidyEndDateField>sample string 2</SubsidyEndDateField>
        <SubsidyStartDateField>sample string 1</SubsidyStartDateField>
      </CMSLisData>
    </ListInfo>
    <LivingStatus>sample string 37</LivingStatus>
    <MedID>sample string 12</MedID>
    <MedicaidEndDate>sample string 36</MedicaidEndDate>
    <MedicaidStartDate>sample string 35</MedicaidStartDate>
    <MedicaidStatus>sample string 34</MedicaidStatus>
    <MedicareInEligibilityInfo>
      <CMSMedicareInEligibilityData>
        <MedicareIneligibilityEndDateField>sample string 2</MedicareIneligibilityEndDateField>
        <MedicareIneligibilityStartDateField>sample string 1</MedicareIneligibilityStartDateField>
      </CMSMedicareInEligibilityData>
      <CMSMedicareInEligibilityData>
        <MedicareIneligibilityEndDateField>sample string 2</MedicareIneligibilityEndDateField>
        <MedicareIneligibilityStartDateField>sample string 1</MedicareIneligibilityStartDateField>
      </CMSMedicareInEligibilityData>
    </MedicareInEligibilityInfo>
    <MiddleInitial>sample string 15</MiddleInitial>
    <NuncMoInfo>
      <CMSNuncMoData>
        <TotUncovMthsField>sample string 4</TotUncovMthsField>
        <UncmoIndField>sample string 3</UncmoIndField>
        <UncovMthsField>sample string 2</UncovMthsField>
        <UncovMthsStartDateField>sample string 1</UncovMthsStartDateField>
      </CMSNuncMoData>
      <CMSNuncMoData>
        <TotUncovMthsField>sample string 4</TotUncovMthsField>
        <UncmoIndField>sample string 3</UncmoIndField>
        <UncovMthsField>sample string 2</UncovMthsField>
        <UncovMthsStartDateField>sample string 1</UncovMthsStartDateField>
      </CMSNuncMoData>
    </NuncMoInfo>
    <PartAEntitleEndDate>sample string 20</PartAEntitleEndDate>
    <PartAEntitlementDate>sample string 19</PartAEntitlementDate>
    <PartBEntitleEndDate>sample string 22</PartBEntitleEndDate>
    <PartBEntitlementDate>sample string 21</PartBEntitlementDate>
    <PartDEligibleDate>sample string 42</PartDEligibleDate>
    <PartDHistoryInfo>
      <CMSPartDHistory>
        <PartDEndDateField>sample string 2</PartDEndDateField>
        <PartDStartDateField>sample string 1</PartDStartDateField>
      </CMSPartDHistory>
      <CMSPartDHistory>
        <PartDEndDateField>sample string 2</PartDEndDateField>
        <PartDStartDateField>sample string 1</PartDStartDateField>
      </CMSPartDHistory>
    </PartDHistoryInfo>
    <PotentialUncvrdMths>sample string 40</PotentialUncvrdMths>
    <PotentialUncvrdMthsEffDate>sample string 41</PotentialUncvrdMthsEffDate>
    <PriorEnrollmentInfo>
      <CMSPriorEnrollmentData>
        <PriorDrugPlanIndField>sample string 7</PriorDrugPlanIndField>
        <PriorEGHPField>sample string 3</PriorEGHPField>
        <PriorEnrollSourceCode>sample string 8</PriorEnrollSourceCode>
        <PriorPBPField>sample string 2</PriorPBPField>
        <PriorPlanEnrollmentDateField>sample string 5</PriorPlanEnrollmentDateField>
        <PriorPlanIdField>sample string 1</PriorPlanIdField>
        <PriorPlanTypeCodeField>sample string 4</PriorPlanTypeCodeField>
        <priorPlanEnrollmentEndDate>sample string 6</priorPlanEnrollmentEndDate>
      </CMSPriorEnrollmentData>
      <CMSPriorEnrollmentData>
        <PriorDrugPlanIndField>sample string 7</PriorDrugPlanIndField>
        <PriorEGHPField>sample string 3</PriorEGHPField>
        <PriorEnrollSourceCode>sample string 8</PriorEnrollSourceCode>
        <PriorPBPField>sample string 2</PriorPBPField>
        <PriorPlanEnrollmentDateField>sample string 5</PriorPlanEnrollmentDateField>
        <PriorPlanIdField>sample string 1</PriorPlanIdField>
        <PriorPlanTypeCodeField>sample string 4</PriorPlanTypeCodeField>
        <priorPlanEnrollmentEndDate>sample string 6</priorPlanEnrollmentEndDate>
      </CMSPriorEnrollmentData>
    </PriorEnrollmentInfo>
    <RDSHistoryInfo>
      <CMSRDSHistoryData>
        <RDSEndDateField>sample string 2</RDSEndDateField>
        <RDSStartDateField>sample string 1</RDSStartDateField>
      </CMSRDSHistoryData>
      <CMSRDSHistoryData>
        <RDSEndDateField>sample string 2</RDSEndDateField>
        <RDSStartDateField>sample string 1</RDSStartDateField>
      </CMSRDSHistoryData>
    </RDSHistoryInfo>
    <RaceCd>sample string 17</RaceCd>
    <RequestDOB>sample string 6</RequestDOB>
    <RequestHicNbr>sample string 3</RequestHicNbr>
    <RequestLastName>sample string 5</RequestLastName>
    <RequestMedID>sample string 4</RequestMedID>
    <StateCd>sample string 23</StateCd>
    <TransactionDate>sample string 1</TransactionDate>
    <XrefHicnNumber>sample string 39</XrefHicnNumber>
    <mbdLoadEffDate>sample string 2</mbdLoadEffDate>
  </EligibilityResponse>
  <EligibilityResponse>
    <BirthDate>sample string 18</BirthDate>
    <CountyCd>sample string 24</CountyCd>
    <DeathDate>sample string 38</DeathDate>
    <ESRDEndDate>sample string 33</ESRDEndDate>
    <ESRDStartDate>sample string 32</ESRDStartDate>
    <ESRDStatus>sample string 31</ESRDStatus>
    <EnrollmentInfo>
      <CMSEnrollmentData>
        <DrugPlanIndField>sample string 6</DrugPlanIndField>
        <EGHPField>sample string 3</EGHPField>
        <EnrollSourceCode>sample string 7</EnrollSourceCode>
        <PBPField>sample string 2</PBPField>
        <PlanEnrollmentDateField>sample string 5</PlanEnrollmentDateField>
        <PlanIdField>sample string 1</PlanIdField>
        <PlanTypeCodeField>sample string 4</PlanTypeCodeField>
      </CMSEnrollmentData>
      <CMSEnrollmentData>
        <DrugPlanIndField>sample string 6</DrugPlanIndField>
        <EGHPField>sample string 3</EGHPField>
        <EnrollSourceCode>sample string 7</EnrollSourceCode>
        <PBPField>sample string 2</PBPField>
        <PlanEnrollmentDateField>sample string 5</PlanEnrollmentDateField>
        <PlanIdField>sample string 1</PlanIdField>
        <PlanTypeCodeField>sample string 4</PlanTypeCodeField>
      </CMSEnrollmentData>
    </EnrollmentInfo>
    <FirstName>sample string 14</FirstName>
    <FoundHICNNumber>sample string 7</FoundHICNNumber>
    <FoundMedID>sample string 8</FoundMedID>
    <FoundNameOrDOB>sample string 9</FoundNameOrDOB>
    <GenderCd>sample string 16</GenderCd>
    <HICNNumber>sample string 11</HICNNumber>
    <HospiceEndDate>sample string 27</HospiceEndDate>
    <HospiceStartDate>sample string 26</HospiceStartDate>
    <HospiceStatus>sample string 25</HospiceStatus>
    <InquiryResponse>sample string 10</InquiryResponse>
    <InstitutionalizedEndDate>sample string 30</InstitutionalizedEndDate>
    <InstitutionalizedStartDate>sample string 29</InstitutionalizedStartDate>
    <InstitutionalizedStatus>sample string 28</InstitutionalizedStatus>
    <LastName>sample string 13</LastName>
    <ListInfo>
      <CMSLisData>
        <CopayLevelField>sample string 3</CopayLevelField>
        <PartDPremSubPctField>sample string 4</PartDPremSubPctField>
        <SubsidyEndDateField>sample string 2</SubsidyEndDateField>
        <SubsidyStartDateField>sample string 1</SubsidyStartDateField>
      </CMSLisData>
      <CMSLisData>
        <CopayLevelField>sample string 3</CopayLevelField>
        <PartDPremSubPctField>sample string 4</PartDPremSubPctField>
        <SubsidyEndDateField>sample string 2</SubsidyEndDateField>
        <SubsidyStartDateField>sample string 1</SubsidyStartDateField>
      </CMSLisData>
    </ListInfo>
    <LivingStatus>sample string 37</LivingStatus>
    <MedID>sample string 12</MedID>
    <MedicaidEndDate>sample string 36</MedicaidEndDate>
    <MedicaidStartDate>sample string 35</MedicaidStartDate>
    <MedicaidStatus>sample string 34</MedicaidStatus>
    <MedicareInEligibilityInfo>
      <CMSMedicareInEligibilityData>
        <MedicareIneligibilityEndDateField>sample string 2</MedicareIneligibilityEndDateField>
        <MedicareIneligibilityStartDateField>sample string 1</MedicareIneligibilityStartDateField>
      </CMSMedicareInEligibilityData>
      <CMSMedicareInEligibilityData>
        <MedicareIneligibilityEndDateField>sample string 2</MedicareIneligibilityEndDateField>
        <MedicareIneligibilityStartDateField>sample string 1</MedicareIneligibilityStartDateField>
      </CMSMedicareInEligibilityData>
    </MedicareInEligibilityInfo>
    <MiddleInitial>sample string 15</MiddleInitial>
    <NuncMoInfo>
      <CMSNuncMoData>
        <TotUncovMthsField>sample string 4</TotUncovMthsField>
        <UncmoIndField>sample string 3</UncmoIndField>
        <UncovMthsField>sample string 2</UncovMthsField>
        <UncovMthsStartDateField>sample string 1</UncovMthsStartDateField>
      </CMSNuncMoData>
      <CMSNuncMoData>
        <TotUncovMthsField>sample string 4</TotUncovMthsField>
        <UncmoIndField>sample string 3</UncmoIndField>
        <UncovMthsField>sample string 2</UncovMthsField>
        <UncovMthsStartDateField>sample string 1</UncovMthsStartDateField>
      </CMSNuncMoData>
    </NuncMoInfo>
    <PartAEntitleEndDate>sample string 20</PartAEntitleEndDate>
    <PartAEntitlementDate>sample string 19</PartAEntitlementDate>
    <PartBEntitleEndDate>sample string 22</PartBEntitleEndDate>
    <PartBEntitlementDate>sample string 21</PartBEntitlementDate>
    <PartDEligibleDate>sample string 42</PartDEligibleDate>
    <PartDHistoryInfo>
      <CMSPartDHistory>
        <PartDEndDateField>sample string 2</PartDEndDateField>
        <PartDStartDateField>sample string 1</PartDStartDateField>
      </CMSPartDHistory>
      <CMSPartDHistory>
        <PartDEndDateField>sample string 2</PartDEndDateField>
        <PartDStartDateField>sample string 1</PartDStartDateField>
      </CMSPartDHistory>
    </PartDHistoryInfo>
    <PotentialUncvrdMths>sample string 40</PotentialUncvrdMths>
    <PotentialUncvrdMthsEffDate>sample string 41</PotentialUncvrdMthsEffDate>
    <PriorEnrollmentInfo>
      <CMSPriorEnrollmentData>
        <PriorDrugPlanIndField>sample string 7</PriorDrugPlanIndField>
        <PriorEGHPField>sample string 3</PriorEGHPField>
        <PriorEnrollSourceCode>sample string 8</PriorEnrollSourceCode>
        <PriorPBPField>sample string 2</PriorPBPField>
        <PriorPlanEnrollmentDateField>sample string 5</PriorPlanEnrollmentDateField>
        <PriorPlanIdField>sample string 1</PriorPlanIdField>
        <PriorPlanTypeCodeField>sample string 4</PriorPlanTypeCodeField>
        <priorPlanEnrollmentEndDate>sample string 6</priorPlanEnrollmentEndDate>
      </CMSPriorEnrollmentData>
      <CMSPriorEnrollmentData>
        <PriorDrugPlanIndField>sample string 7</PriorDrugPlanIndField>
        <PriorEGHPField>sample string 3</PriorEGHPField>
        <PriorEnrollSourceCode>sample string 8</PriorEnrollSourceCode>
        <PriorPBPField>sample string 2</PriorPBPField>
        <PriorPlanEnrollmentDateField>sample string 5</PriorPlanEnrollmentDateField>
        <PriorPlanIdField>sample string 1</PriorPlanIdField>
        <PriorPlanTypeCodeField>sample string 4</PriorPlanTypeCodeField>
        <priorPlanEnrollmentEndDate>sample string 6</priorPlanEnrollmentEndDate>
      </CMSPriorEnrollmentData>
    </PriorEnrollmentInfo>
    <RDSHistoryInfo>
      <CMSRDSHistoryData>
        <RDSEndDateField>sample string 2</RDSEndDateField>
        <RDSStartDateField>sample string 1</RDSStartDateField>
      </CMSRDSHistoryData>
      <CMSRDSHistoryData>
        <RDSEndDateField>sample string 2</RDSEndDateField>
        <RDSStartDateField>sample string 1</RDSStartDateField>
      </CMSRDSHistoryData>
    </RDSHistoryInfo>
    <RaceCd>sample string 17</RaceCd>
    <RequestDOB>sample string 6</RequestDOB>
    <RequestHicNbr>sample string 3</RequestHicNbr>
    <RequestLastName>sample string 5</RequestLastName>
    <RequestMedID>sample string 4</RequestMedID>
    <StateCd>sample string 23</StateCd>
    <TransactionDate>sample string 1</TransactionDate>
    <XrefHicnNumber>sample string 39</XrefHicnNumber>
    <mbdLoadEffDate>sample string 2</mbdLoadEffDate>
  </EligibilityResponse>
</ArrayOfEligibilityResponse>

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