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Frequently Asked Questions (FAQs) for 834 Transactions


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Q.

Will the new eMedNY 834 be posted on the same SFTP server as the NYSoH 834? Will we have to get it from a different folder path?

 

 

Published: 11/07/2019

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Updated: 11/07/2019

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QID: L2

 
 

A.

No, the NYSOH 834 and the eMedNY 834 are different files; the eMedNY version will only be available via eMedNY access methods. Please refer to section 4.2 of the Managed Care Enrollment (MCE) 834 Companion Guide on emedny.org under the eMedNY HIPAA Support tab for details.

 
 

Q.

Where will the eMedNY 834 Client Enrollment file be delivered?

 

 

Published: 11/07/2019

|

Updated: 11/07/2019

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QID: L3

 
 

Q.

Will the first file after go-live be an audit file?

 

 

Published: 11/25/2019

|

Updated: 11/25/2019

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QID: L4

 
 

Q.

For support questions after go-live, who is the contact?

 

 

Published: 11/25/2019

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Updated: 11/25/2019

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QID: L5

 
 

Q.

Please advise the status of the various Maximus NYMC files (A, E, L, T, DU, Homeless etc.). What files will we continue to receive, and which will be discontinued?

 

 

Published: 12/10/2019

|

Updated: 12/10/2019

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QID: L6

 
 

Q.

Does eMedNY/DOH expect to receive effectuations from Plans?

 

 

Published: 11/01/2019

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Updated: 11/01/2019

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QID: L8

 
 

Q.

Will there be any sort of error reporting for effectuations that are rejected by DOH? If so, what type of report will it be and how frequently will it be received?

 

 

Published: 11/01/2019

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Updated: 11/01/2019

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QID: L9

 
 

Q.

Will issuers be required to perform any sort of enrollment reconciliation with DOH?

 

 

Published: 11/25/2019

|

Updated: 01/03/2020

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QID: L11

 
 

Q.

Will the submission of effectuations drive capitation payments?

 

 

Published: 11/01/2019

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Updated: 11/01/2019

|

QID: L12

 
 

Q.

What is the QHP Policy ID referenced in 2000 REF - Member Supplemental Identifier noted in the 834 MCE Companion Guide, and does the value need to be stored within our system?

 

 

Published: 12/10/2019

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Updated: 12/10/2019

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QID: L13

 
 

Q.

If we have several different products (HARP, PACE etc.) will we receive one file?

 

 

Published: 11/01/2019

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Updated: 11/01/2019

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QID: L14

 
 

Q.

Currently, Plans get Retro disenrollment forms from the local districts (LDSS) to term a member based on a disenrollment reason code (i.e. 01 -  Incarceration, 02 Death). Should a Plan term the member prior to submitting a cancel transaction to the State?

 

 

Published: 01/16/2020

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Updated: 02/25/2020

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QID: L19

 
 

Q.

When the process is transitioned to the 834 format will clients be assigned new CIN numbers?

 

 

Published: 11/01/2019

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Updated: 11/01/2019

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QID: L20

 
 

Q.

How many RRE codes should we expect to receive?

 

 

Published: 11/07/2019

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Updated: 11/07/2019

|

QID: L21

 
 

Q.

Will the 025 maintenance type transaction (reinstatement/re-enrollment) be sent on the 834 file? The companion guide only referenced 001, 021, 024 and 030 maintenance type transactions.

 

 

Published: 11/07/2019

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Updated: 11/07/2019

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QID: L24

 
 

Q.

Which date should the Plan use as the Plan enrollment date, 348 Benefit Begin Date or 356 Plan Eligibility Begin Date?

 

 

Published: 11/07/2019

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Updated: 11/07/2019

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QID: L25

 
 

Q.

Which date should the Plan use as the Plan disenrollment date, 349 Benefit End Date or 357 Plan Eligibility End Date?

 

 

Published: 11/07/2019

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Updated: 11/07/2019

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QID: L26

 
 

Q.

Will the Primary Care Physician be provided on the 834-enrollment file?

 

 

Published: 11/07/2019

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Updated: 11/07/2019

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QID: L27

 
 

Q.

Who should the Plan mail correspondences to, "member in care of name" or "responsible party"?

 

 

Published: 12/19/2019

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Updated: 12/19/2019

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QID: L28

 
 

Q.

Will the Expected Date of Confinement (EDC - Due Date) be provided on the 834-enrollment file?

 

 

Published: 11/07/2019

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Updated: 11/07/2019

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QID: L29

 
 

Q.

What would be the source of truth, eMedNY or the 834-enrollment file?

 

 

Published: 11/07/2019

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Updated: 11/07/2019

|

QID: L32

 
 

Q.

Are Head of Household and/or Responsible Party going to be indicated on the eMedNY 834?

 

 

Published: 12/19/2019

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Updated: 12/19/2019

|

QID: L33

 
 

Q.

Will Nursing Home members be on the MCE 834? If so, what details can we expect?

 

 

Published: 12/19/2019

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Updated: 12/19/2019

|

QID: L45

 
 

Q.

Will the Monthly Nursing Home Residents specialty roster continue?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L46

 
 

Q.

Will the Health Commerce System (HCS) site still be used for any roster files?

 

 

Published: 11/25/2019

|

Updated: 01/03/2020

|

QID: L47

 
 

Q.

Will LDSS still notify the plan for a member roster change for the current month?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L48

 
 

Q.

Will the recert date for the upstate counties be included on the 834?

 

 

Published: 12/10/2019

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Updated: 12/10/2019

|

QID: L49

 
 

Q.

With the new 834 process, what will the DOH Guidelines for Confidential Address be?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L50

 
 

Q.

Will there be a monthly correction file?

 

 

Published: 11/25/2019

|

Updated: 11/25/2019

|

QID: L54

 
 

Q.

Will there be mass/retro rate adjustments communicated in the 834?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L55

 
 

Q.

How will unborn/newborns be sent in the 834?

 

 

Published: 12/10/2019

|

Updated: 01/03/2020

|

QID: L57

 
 

Q.

Third Party Liability Coverage - will this be populated?

 

 

Published: 11/25/2019

|

Updated: 11/25/2019

|

QID: L58

 
 

Q.

How will the January test files be delivered?

 

 

Published: 01/08/2020

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Updated: 01/08/2020

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QID: L63

 
 

Q.

Will the values on the Verification file in the 348 (Benefit Begin Date) and 356 (Plan Eligibility Begin Date) dates show each member's original effective date, or will all members have the same date – the 1st of the month that the Verification file represents?

 

 

Published: 12/19/2019

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Updated: 12/19/2019

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QID: L64

 
 

Q.

If we have multiple ZIP files in a single day, with multiple 834s contained within each ZIP file, do we return a separate X12 999 Acknowledgement for each 834 within the zip file?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L65

 
 

Q.

What types of transactions can we receive on a single file for a single member?

 

 

Published: 01/08/2020

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Updated: 01/08/2020

|

QID: L67

 
 

Q.

Can we get a breakdown of what the BGN02 value represents?

 

 

Published: 01/08/2020

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Updated: 01/08/2020

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QID: L68

 
 

Q.

Can we expect the "care name" or "guardian name" format in both downstate and upstate records to start being consistently first name first and last name last on the 834, or will it continue to be different from the 2 sources?

 

 

Published: 01/08/2020

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Updated: 01/08/2020

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QID: L71

 
 

Q.

There are a number of actions that HRA/LDSS does that brings Medicaid coverage down, E.g.: turning 65/ Pool/trust/CHHA. Will this impact the 834 transaction we receive, and, if so, how do we know HRA initiated this? How do we know if we have follow up?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L72

 
 

Q.

How will the plans be notified when a member loses or adds SSI?

 

 

Published: 01/08/2020

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Updated: 01/08/2020

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QID: L73

 
 

Q.

What is the plan regarding continued use of the supplemental files: RRE, NAMI, Disenrollments. If they are going to continue are the plans supposed to use this data to determine member benefit eligibility?

 

 

Published: 01/08/2020

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Updated: 01/08/2020

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QID: L76

 
 

Q.

It was mentioned that Maximus files will continue. Should these files be used for our source of eligibility?

 

 

Published: 12/19/2019

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Updated: 12/19/2019

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QID: L77

 
 

Q.

Maximus E files are daily and eMedNY 834s will be daily, so if Maximus enrolls a member and sends them on the E file and they don't appear on the daily eMedNY file should we enroll the member based on the E file or not?

 

 

Published: 12/19/2019

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Updated: 12/19/2019

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QID: L78

 
 

Q.

Maximus T files from Maximus are daily but eMedNY is only sending terms once a month. Should we term based on the Maximus T file or wait for eMedNY term file?

 

 

Published: 12/19/2019

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Updated: 12/19/2019

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QID: L79

 
 

Q.

Will all Rosters be replaced with 834 (MLTC, Medicaid Advantage & Medicaid Advantage Plus, MMC, HARP)? The Companion guide appears to only refer to MMC and MLTC?

 

 

Published: 12/19/2019

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Updated: 01/03/2020

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QID: L80

 
 

Q.

What will the eMedNY 834 file naming structures be for Production and Test files?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L81

 
 

Q.

Will Plans continue to get a new CIN assigned to a member when they move from/to NYC?

 

 

Published: 12/19/2019

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Updated: 12/19/2019

|

QID: L82

 
 

Q.

We noticed that the disenrollment reason codes only had 2 in the companion guide and we would like the same level of detailed disenrollment's that NYSoH provides.

 

 

Published: 12/19/2019

|

Updated: 01/03/2020

|

QID: L83

 
 

Q.

How will newborns be enrolled retroactively to month of birth? Prospective Add with a retro change?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L85

 
 

Q.

What is the process when members move from one plan to another (ex. MMC to HARP)?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L86

 
 

Q.

If terms are only happening on the 25th of the month will we only get "adds" for a member moving from MMC to HARP after the term on the 25th?

 

 

Published: 01/08/2020

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Updated: 01/08/2020

|

QID: L87

 
 

Q.

Where will we be able to find the original plan effective date for the member on the initial "030" maintenance "full file"?

 

 

Published: 01/08/2020

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Updated: 01/08/2020

|

QID: L89

 
 

Q.

Will a Reinstate be sent as a 021 ADD transaction?
Will we receive a 024 Term transaction prior to receiving the 021?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L93

 
 

Q.

Will other HCS reports be replaced by the 834 (Fair Hearing, Newborns, TPHI, etc.)?

 

 

Published: 01/29/2020

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Updated: 01/29/2020

|

QID: L94

 
 

Q.

With the C/O being replaced with a Resp Person loop in the 834, will there no longer be a 3rd address line with a 'C/O' reference?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L95

 
 

Q.

Currently, when Plans receive retroactive disenrollments from the LDSS, should the Plan cancel the member?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L101

 
 

Q.

When we receive a disenrollment from the LDSS, do we need to submit a cancel transaction to eMedNY?

 

 

Published: 01/16/2020

|

Updated: 02/25/2020

|

QID: L102

 
 

Q.

What will happen to the 270/271 Process?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L103

 
 

Q.

What will happen to the 277 Process?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L104

 
 

Q.

Is there any possibility to get the SFTP file transfer process set up so it's more automated like NYSoH?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L105

 
 

Q.

If we detect Level 1 compliance errors on the 834 validation, how should those be communicated back to eMedNY?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L107

 
 

Q.

What will be the process for the SDOH Retro disenrollments report?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L108

 
 

Q.

How do we handle 834 transactions received from eMedNY where we would be unable to send a 999 acknowledgement?

 

 

Published: 01/16/2020

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Updated: 01/16/2020

|

QID: L111

 
 

Q.

Can members change any demographic information through the plan or must they contact LDSS? How should these changes be reported to eMedNY if through the plan?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L112

 
 

Q.

Is there a separate document for what is expected in the "999 Interchange Acknowledgement" response file that is expected from the plans?

 

 

Published: 01/08/2020

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Updated: 01/08/2020

|

QID: L113

 
 

Q.

How will temporary loss of Medicaid eligibility be indicated? Will temporary loss of Medicaid eligibility still require us to cover the member until they return to the roster or are disenrolled?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L115

 
 

Q.

Will the HIV SNP rate codes be provided in the 834 file?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L116

 
 

Q.

Will transgender/homeless/emancipated members be indicated on in the 834 file?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L118

 
 

Q.

How should we handle potential day-to-day changes to the elements involved in rate code calculation (age, sex, Aid Code, HIV status, transgender status, homeless status) and the downstream affect involving premium billing, claims payment and vendor services such as pharmacy and behavioral health that we might receive in the daily 834 file?

 

 

Published: 02/20/2020

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Updated: 02/20/2020

|

QID: L119

 
 

Q.

Should the monthly RRE code file override any RRE code differences that might be sent in the daily 834 file?

 

 

Published: 01/08/2020

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Updated: 02/25/2020

|

QID: L121

 
 

Q.

When we send an 834 Effectuation to eMedNY, what kind of response should we expect from eMedNY for the submission? Will we receive a 999 Acknowledgement or an 834 response in return?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L124

 
 

Q.

Will Plans receive mapping guidance from current Roster to the X12 834 format?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L125

 
 

Q.

When will testing begin for Non-Pilot Plans? How will Non-Pilots receive sample files?

 

 

Published: 02/20/2020

|

Updated: 02/20/2020

|

QID: L126

 
 

Q.

If a client is recertifying Medicaid and missed the verification file, will they come back as retro enrollment on a daily file?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L128

 
 

Q.

Can you clarify what the Renewal Date refers to? Is this the last day of coverage?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L130

 
 

Q.

How does a Plan react to the continuing current files (E, T, U etc.) and the 834? What if members show on these different files with different dates than the 834?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L131

 
 

Q.

If we get a retro Disenroll transaction on the 834 file for months for which the plan has received payment, can we use that transaction to initiate the refund, or will we need to wait for the formal retro term request asking for premiums back?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L132

 
 

Q.

When Roster file data definition differs from the data in the 834 files (e.g. - Ethnicity Code is 6 characters on a Roster and only 1 character on the 834), should we expect the Roster-specific definition to carry over to the new 834, or will it conform to the 834 specifications?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L133

 
 

Q.

If the Spend Down/Excess Income is updated, will the file include the effective date of the change?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L134

 
 

Q.

QHP ID - if plans do not send back effectuations, will this be a risk as it relates to the QHP ID/Plan Assigned Policy ID?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L136

 
 

Q.

If Marital Status is not included on the Roster file, will the eMedNY 834 file have Marital Status populated?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L137

 
 

Q.

Currently on the HARP roster, we receive either TANF or SSI rate codes. Will that continue with the 834, or will the Health Plan receive the HARP rate code?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L138

 
 

Q.

Currently, when a member switches from HIX to Roster and vice-versa, new CINs are bring created. Is there a plan to fix this?

 

 

Published: 02/20/2020

|

Updated: 02/20/2020

|

QID: L139

 
 

Q.

Will the data be sourced by the County, so we know where to go with inquiries?

 

 

Published: 02/20/2020

|

Updated: 02/20/2020

|

QID: L142

 
 

Q.

If we opt not to send Effectuations, would it be possible to send a unique file with address updates?

 

 

Published: 02/20/2020

|

Updated: 02/20/2020

|

QID: L143

 
 

Q.

From the 834 guide - "Member's County of Residence will be identified. When available, a 5-digit FIPS County Code will be sent, otherwise a 2-digit county code will be valued". What are the circumstances when we would get a 2-digit county code instead of a 5-digit FIPS county code?

 

 

Published: 02/20/2020

|

Updated: 02/20/2020

|

QID: L145

 
 

Q.

When a member turns 21, will we get a change record on the 834 with a new rate code?

 

 

Published: 02/20/2020

|

Updated: 02/20/2020

|

QID: L148

 
 

Q.

What are the expected file naming conventions for the 999 and the 834 Effectuation files we send to eMedNY?

 

 

Published: 02/25/2020

|

Updated: 02/25/2020

|

QID: L149