Raw X12 — CIN TT46008R

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1944*|*00501*304649134*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1944*649134*X*005010X279A1~ST*270*9134*005010X279A1~BHT*0022*13*202608091944000001*20260809*1944~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*202608091944000001*00000000ND~NM1*IL*1******MI*TT46008R~EQ*30~DTP*291*D8*20260806~SE*13*9134~GE*1*649134~IEA*1*304649134~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1544*^*00501*311858630*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154404*311858630*X*005010X279A1~ST*271*311858630*005010X279A1~BHT*0022*11*202608091944000001*20260809*154404~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*202608091944000001*00000000ND~NM1*IL*1*ACEMYAN*VERJIN****MI*TT46008R~N3*57-14 LITTLE NECK PKWY~N4*LITTLE NECK*NY*11362~DMG*D8*19371112*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260201~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 500~LS*2120~NM1*Y2*2*VILLAGE SENIOR SVC CORP PARTIAL LTC*****PI*VL~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*1*IND*88~SE*30*311858630~GE*1*311858630~IEA*1*311858630~