Raw X12 — CIN RN94830N

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1946*|*00501*304813557*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1946*813557*X*005010X279A1~ST*270*3557*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*RN94830N~EQ*30~DTP*291*D8*20260806~SE*13*3557~GE*1*813557~IEA*1*304813557~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1546*^*00501*311950530*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154649*311950530*X*005010X279A1~ST*271*311950530*005010X279A1~BHT*0022*11*202608091946000001*20260809*154649~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*DZHURAYEVA*OSNAT****MI*RN94830N~N3*140-39 69TH AVE~N4*FLUSHING*NY*11367~DMG*D8*19640122*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~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~SE*29*311950530~GE*1*311950530~IEA*1*311950530~