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Raw X12 — CIN RV02423F
270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260812*1952*|*00501*564330885*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1952*330885*X*005010X279A1~ST*270*0885*005010X279A1~BHT*0022*13*202608121952000001*20260812*1952~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*202608121952000001*00000000ND~NM1*IL*1******MI*RV02423F~EQ*30~DTP*291*D8*20260813~SE*13*0885~GE*1*330885~IEA*1*564330885~
271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260812*1552*^*00501*529036530*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155206*529036530*X*005010X279A1~ST*271*529036530*005010X279A1~BHT*0022*11*202608121952000001*20260812*155206~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*202608121952000001*00000000ND~NM1*IL*1*BARNESHUNTER*NAOMI****MI*RV02423F~N3*36 SCHENECTADY AVENUE~N4*BROOKLYN*NY*11213~DMG*D8*19480412*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260801~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=03~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*929485885~LS*2120~NM1*P4*2*UNITED HEALTH CARE*****PI*F7~N3*P O BOX 466~N4*WARWICK*RI*028870466~PER*IC*PROVIDER SERVICES*TE*8003080293~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*084405030~REF*6P*236369~LS*2120~NM1*P4*2*METLIFE*****PI*MG~N3*1095 AVENUE OF THE AMERICAS~N4*NEW YORK*NY*100366726~LE*2120~EB*R*IND*30~REF*18*6FE0UN3TQ04~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*60*529036530~GE*1*529036530~IEA*1*529036530~