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Raw X12 — CIN RN95006Q
270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260809*1949*|*00501*304973759*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1949*973759*X*005010X279A1~ST*270*3759*005010X279A1~BHT*0022*13*202608091949000001*20260809*1949~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*202608091949000001*00000000ND~NM1*IL*1******MI*RN95006Q~EQ*30~DTP*291*D8*20260806~SE*13*3759~GE*1*973759~IEA*1*304973759~
271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260809*1549*^*00501*312057830*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154929*312057830*X*005010X279A1~ST*271*312057830*005010X279A1~BHT*0022*11*202608091949000001*20260809*154929~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*202608091949000001*00000000ND~NM1*IL*1*KARLEWICZ*GRAZYNA****MI*RN95006Q~N3*135 INDIA STREET 6~N4*BKLYN*NY*11222~DMG*D8*19471013*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 508~MSG*RECERT MONTH=04~LS*2120~NM1*Y2*2*ELDERSERVE HEALTH INC MLTCP*****PI*EH~N3*80 W 225TH ST FL 3~N4*BRONX*NY*104637002~PER*IC*PROVIDER SERVICES*TE*8003703600~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*U4598615102~REF*6P*3335083~LS*2120~NM1*P4*2*CIGNA*****PI*C4~N3*P O BOX 3598~N4*SCRANTON*PA*185050598~PER*IC*PROVIDER SERVICES*TE*8002446224~LE*2120~EB*R*IND*30~REF*18*109802842~REF*6P*BJL001~LS*2120~NM1*P4*2*DAVIS VISION*****PI*90~N3*PO BOX 1501~N4*LATHAM*NY*121108001~PER*IC*PROVIDER SERVICES*TE*8009995431~LE*2120~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*1K10TT0RY09~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*62*312057830~GE*1*312057830~IEA*1*312057830~