Raw X12 — CIN VP75369Z

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260726*1715*|*00501*086104719*1*P*:~GS*HS*00ND*EMEDNYREL*20260726*1715*104719*X*005010X279A1~ST*270*4719*005010X279A1~BHT*0022*13*202607261715000001*20260726*1715~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*202607261715000001*00000000ND~NM1*IL*1******MI*VP75369Z~EQ*30~DTP*291*D8*20260726~SE*13*4719~GE*1*104719~IEA*1*086104719~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260726*1315*^*00501*269490830*0*P*|~GS*HB*EMEDNYREL*00ND*20260726*131501*269490830*X*005010X279A1~ST*271*269490830*005010X279A1~BHT*0022*11*202607261715000001*20260726*131501~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*202607261715000001*00000000ND~NM1*IL*1*AVILES*MARIANO****MI*VP75369Z~N3*609 METROPOLITAN AVE          4C~N4*BROOKLYN*NY*11211~DMG*D8*19360202*M~DTP*472*D8*20260726~DTP*346*D8*20260701~DTP*102*D8*20251001~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~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*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*6UE4WG5CG77~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*269490830~GE*1*269490830~IEA*1*269490830~