Raw X12 — CIN MU93036A

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1944*|*00501*304659418*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1944*659418*X*005010X279A1~ST*270*9418*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*MU93036A~EQ*30~DTP*291*D8*20260806~SE*13*9418~GE*1*659418~IEA*1*304659418~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1544*^*00501*311865630*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154415*311865630*X*005010X279A1~ST*271*311865630*005010X279A1~BHT*0022*11*202608091944000001*20260809*154415~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*ALMONTE*MERCEDES****MI*MU93036A~N3*10912    139TH STREET~N4*JAMAICA*NY*11435~DMG*D8*19480102*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260701~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*PD~MSG*CNTY CD=66 508~MSG*RECERT MONTH=05~LS*2120~NM1*Y2*2*HEALTH FIRST PHSP INC*****PI*SF~N3*100 CHURCH ST FL 18~N4*NEW YORK*NY*100072601~PER*IC*PROVIDER SERVICES*TE*8888011660~LE*2120~EB*B*IND*30***29*0~EB*1*IND*88~EB*W*IND*CQ~LS*2120~NM1*Y2*2*NORTH SHORE UNIVERSITY HOSPITAL*****XX*1932472107~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*NORTH SHORE UNIVERSITY HOSPITAL*****XX*1932472107~LE*2120~SE*39*311865630~GE*1*311865630~IEA*1*311865630~