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Raw X12 — CIN WC00122M
270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260809*2011*|*00501*306279919*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*2011*279919*X*005010X279A1~ST*270*9919*005010X279A1~BHT*0022*13*202608092011000001*20260809*2011~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*202608092011000001*00000000ND~NM1*IL*1******MI*WC00122M~EQ*30~DTP*291*D8*20260806~SE*13*9919~GE*1*279919~IEA*1*306279919~
271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260809*1611*^*00501*318068930*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*161115*318068930*X*005010X279A1~ST*271*318068930*005010X279A1~BHT*0022*11*202608092011000001*20260809*161115~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*202608092011000001*00000000ND~NM1*IL*1*KOIFMAN*ACIA****MI*WC00122M~N3*62 BRIGHTON 1ST TERR~N4*BROOKLYN*NY*11235~DMG*D8*19450825*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=05~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*9003866175~REF*6P*1199RX~LS*2120~NM1*P4*2*1199 SEIU NATIONAL BEN FUND*****PI*LO~N3*310 W 43RD ST~N4*NEW YORK*NY*10036~PER*IC*PROVIDER SERVICES*TE*6464737160~LE*2120~EB*R*IND*30~REF*18*W263438601~REF*6P*011533001200800~LS*2120~NM1*P4*2*AETNA (DENTAL)*****PI*ACD~N3*PO BOX 14094~N4*LEXINGTON*KY*405124094~PER*IC*PROVIDER SERVICES*TE*8772386200~LE*2120~EB*R*IND*30~REF*6P*H5522~LS*2120~NM1*P4*2*AETNA MEDICARE*****PI*H5522~N3*PO BOX 7405~N4*LONDON*KY*40742~PER*IC*PROVIDER SERVICES*TE*8887594415~LE*2120~EB*R*IND*30~REF*18*7TA2HC3FY88~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*61*318068930~GE*1*318068930~IEA*1*318068930~