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Raw X12 — CIN WW78642U
270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260810*1031*|*00501*357877081*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1031*877081*X*005010X279A1~ST*270*7081*005010X279A1~BHT*0022*13*202608101031000001*20260810*1031~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*202608101031000001*00000000ND~NM1*IL*1******MI*WW78642U~EQ*30~DTP*291*D8*20260806~SE*13*7081~GE*1*877081~IEA*1*357877081~
271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260810*0631*^*00501*238049330*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*063112*238049330*X*005010X279A1~ST*271*238049330*005010X279A1~BHT*0022*11*202608101031000001*20260810*063112~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*202608101031000001*00000000ND~NM1*IL*1*PEGUERO*SIXTA****MI*WW78642U~N3*366 RIDGEWOOD AVE BSMNT~N4*BROOKLYN*NY*11208~DMG*D8*19480426*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=02~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*583159219~LS*2120~NM1*P4*2*UNION INP/OPT*****PI*09~N3*CONTACT LOCAL DSS*ASK FOR TPR WORKER~N4*APPROPRIATE CITY*NY*10010~LE*2120~EB*R*IND*30~REF*18*WW78642U~LS*2120~NM1*P4*2*LOCAL 1199 SEIU HC*****PI*LOHC~N3*PO BOX 1007 TIMES SQUARE STATION~N4*NEW YORK*NY*101081007~PER*IC*PROVIDER SERVICES*TE*6464739200~LE*2120~EB*R*IND*30~REF*18*WW78642U~LS*2120~NM1*P4*2*LOCAL 1199 SEIU HC*****PI*LOHC~N3*PO BOX 1007 TIMES SQUARE STATION~N4*NEW YORK*NY*101081007~PER*IC*PROVIDER SERVICES*TE*6464739200~LE*2120~EB*R*IND*30~REF*6P*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*8M35G34NT66~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*65*238049330~GE*1*238049330~IEA*1*238049330~