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Raw X12 — CIN PF38646X
270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260809*2006*|*00501*305987968*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*2006*987968*X*005010X279A1~ST*270*7968*005010X279A1~BHT*0022*13*202608092006000001*20260809*2006~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*202608092006000001*00000000ND~NM1*IL*1******MI*PF38646X~EQ*30~DTP*291*D8*20260806~SE*13*7968~GE*1*987968~IEA*1*305987968~
271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260809*1606*^*00501*316678530*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*160623*316678530*X*005010X279A1~ST*271*316678530*005010X279A1~BHT*0022*11*202608092006000001*20260809*160623~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*202608092006000001*00000000ND~NM1*IL*1*KUPREISHVILI*NANA****MI*PF38646X~N3*1404 AVENUE P~N4*BROOKLYN*NY*11229~DMG*D8*19550718*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260601~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=11~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*054444360~REF*6P*0~LS*2120~NM1*P4*2*HUMANA MILITARY EAST TRICARE*****PI*CA~N3*PO BOX 870140*HEALTHNET FEDERAL SERVICES CLAIMS~N4*SURFSIDE BEACH*SC*295879740~PER*IC*PROVIDER SERVICES*TE*8004445445~LE*2120~EB*R*IND*30~REF*18*797105311202~REF*6P*APNN~LS*2120~NM1*P4*2*EXPRESS SCRIPTS*****PI*EXS~N3*PO BOX 2863~N4*CLINTON*IA*527332863~PER*IC*PROVIDER SERVICES*TE*8002064005~LE*2120~EB*R*IND*30~REF*18*130571177~REF*6P*422114~LS*2120~NM1*P4*2*HUMANA - DENTAL*****PI*P6DNT~N3*PO BOX 14611~N4*LEXINGTON*KY*405124611~PER*IC*PROVIDER SERVICES*TE*8778771051~LE*2120~EB*R*IND*30~REF*6P*H8432~LS*2120~NM1*P4*2*EMPIRE MEDIBLUE CORE*****PI*H8432~N3*EMPIRE MEDIBLUE*PO BOX 1407 CHURCH STREET STATION~N4*NEW YORK*NY*100081407~PER*IC*PROVIDER SERVICES*TE*8557311090~LE*2120~EB*R*IND*30~REF*18*1UT0JM2YQ45~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*70*316678530~GE*1*316678530~IEA*1*316678530~