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Raw X12 — CIN WJ25948W
270 Request
ISA*00* *00* *ZZ*00ND *ZZ*EMEDNYREL *260813*1922*|*00501*648938640*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1922*938640*X*005010X279A1~ST*270*8640*005010X279A1~BHT*0022*13*202608131922000001*20260813*1922~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*202608131922000001*00000000ND~NM1*IL*1******MI*WJ25948W~EQ*30~DTP*291*D8*20260814~SE*13*8640~GE*1*938640~IEA*1*648938640~
271 Response
ISA*00* *00* *ZZ*EMEDNYREL *ZZ*00ND *260813*1522*^*00501*541549930*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152214*541549930*X*005010X279A1~ST*271*541549930*005010X279A1~BHT*0022*11*202608131922000001*20260813*152214~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*202608131922000001*00000000ND~NM1*IL*1*GARCIA*RAMON****MI*WJ25948W~N3*1929 ANDREWS AVENUE 5N~N4*BRONX*NY*10453~DMG*D8*19460115*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20251201~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*C2~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*VILLAGE SENIOR SERVICES CORP MAP*****PI*VM~N3*112 CHARLES ST FL 2~N4*NEW YORK*NY*100142653~PER*IC*PROVIDER SERVICES*TE*8557692500~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*W*IND*CQ~LS*2120~NM1*Y2*2*ESSEN MEDICAL ASSOCIATES PC*****XX*1366418709~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*SRH CHN LEAD HEALTH HOME LLC*****XX*1750053948~LE*2120~EB*R*IND*30~REF*18*9003024744~REF*6P*01~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*6P*H2168~LS*2120~NM1*P4*2*VILLAGECAREMAX MEDICARE TOTAL ADVAN*****PI*H2168~N3*P O BOX 5426~N4*HAUPPAUGE*NY*117885426~PER*IC*PROVIDER SERVICES*TE*8004696292~LE*2120~EB*R*IND*30~REF*18*2PG9T85HD16~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*62*541549930~GE*1*541549930~IEA*1*541549930~