ISA*00*          *00*          *ZZ*EMEDNYBAT      *ZZ*ETIN           *100101*1000*^*00501*006000600*0*T*:~GS*HP*EMEDNYBAT*ETIN*20100101*1050*6000600*X*005010X221A1~ST*835*1740~BPR*I*45.75*C*ACH*CCP*01*111*DA*33*1234567890**01*111*DA*22*20100101~TRN*1*10100000000*1000000000~REF*EV*ETIN~DTM*405*20100101~N1*PR*NYSDOH~N3*OFFICE OF HEALTH INSURANCE PROGRAMS*CORNING TOWER, EMPIRE STATE PLAZA~N4*ALBANY*NY*122370080~PER*BL*PROVIDER SERVICES*TE*8003439000*UR*www.emedny.org~N1*PE*MAJOR MEDICAL PROVIDER*XX*9999999995~REF*TJ*000000000~LX*1~CLP*PATIENT ACCOUNT NUMBER*1*34.25*34.25**MC*1000210000000030*11~NM1*QC*1*SUBMITTED LAST*SUBMITTED FIRST****MI*LL99999L~NM1*74*1*CORRECTED LAST*CORRECTED FIRST~REF*EA*PATIENT ACCOUNT NUMBER~DTM*232*20100101~DTM*233*20100101~AMT*AU*34.25~SVC*HC:V2020:RB*6*6**1~DTM*472*20100101~AMT*B6*6~SVC*HC:V2700:RB*2.75*2.75**1~DTM*472*20100101~AMT*B6*2.75~SVC*HC:V2103:RB*5.5*5.5**1~DTM*472*20100101~AMT*B6*5.5~SVC*HC:S0580*20*20**2~DTM*472*20100101~AMT*B6*20~CLP*PATIENT ACCOUNT NUMBER*2*34*0**MC*1000220000000020*11~NM1*QC*1*SUBMITTED LAST*SUBMITTED FIRST****MI*LL88888L~NM1*74*1*CORRECTED LAST*CORRECTED FIRST~REF*EA*PATIENT ACCOUNT NUMBER~DTM*232*20100101~DTM*233*20100101~SVC*HC:V2020*12*0**0~DTM*472*20100101~CAS*CO*29*12~SVC*HC:V2103*22*0**0~DTM*472*20100101~CAS*CO*29*22~CLP*PATIENT ACCOUNT NUMBER*2*34.25*11.5**MC*1000230000000020*11~NM1*QC*1*SUBMITTED LAST*SUBMITTED FIRST****MI*LL77777L~NM1*74*1*CORRECTED LAST*CORRECTED FIRST~REF*EA*PATIENT ACCOUNT NUMBER~DTM*232*20100101~DTM*233*20100101~AMT*AU*11.5~SVC*HC:V2020:RB*6*6**1~DTM*472*20100101~AMT*B6*6~SVC*HC:V2103:RB*5.5*5.5**1~DTM*472*20130917~AMT*B6*5.5~SVC*HC:V2700:RB*2.75*0**0~DTM*472*20100101~CAS*CO*251*2.75~LQ*HE*N206~SVC*HC:S0580*20*0**0~DTM*472*20100101~CAS*CO*251*20~LQ*HE*N206~SE*65*1740~GE*1*6000600~IEA*1*006000600~