Raw X12 — CIN XT58446S

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1946*|*00501*304789495*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1946*789495*X*005010X279A1~ST*270*9495*005010X279A1~BHT*0022*13*202608091946000001*20260809*1946~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*202608091946000001*00000000ND~NM1*IL*1******MI*XT58446S~EQ*30~DTP*291*D8*20260806~SE*13*9495~GE*1*789495~IEA*1*304789495~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1546*^*00501*311936630*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154625*311936630*X*005010X279A1~ST*271*311936630*005010X279A1~BHT*0022*11*202608091946000001*20260809*154625~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*202608091946000001*00000000ND~NM1*IL*1*DELAROSA*OLGA*C***MI*XT58446S~N3*9538     95TH ST              1~N4*OZONE PARK*NY*11416~DMG*D8*19521224*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~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*6MT2V63GV00~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*311936630~GE*1*311936630~IEA*1*311936630~