Raw X12 — CIN VN89076T

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1948*|*00501*304880370*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1948*880370*X*005010X279A1~ST*270*0370*005010X279A1~BHT*0022*13*202608091948000001*20260809*1948~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*202608091948000001*00000000ND~NM1*IL*1******MI*VN89076T~EQ*30~DTP*291*D8*20260806~SE*13*0370~GE*1*880370~IEA*1*304880370~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1547*^*00501*311992930*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154756*311992930*X*005010X279A1~ST*271*311992930*005010X279A1~BHT*0022*11*202608091948000001*20260809*154756~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*202608091948000001*00000000ND~NM1*IL*1*GITIN*VALENTIN****MI*VN89076T~N3*527 AVENUE X                  1F~N4*BROOKLYN*NY*11235~DMG*D8*19391013*M~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*1*IND*30**MA Eligible~MSG*CF~MSG*CNTY CD=66 523~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*33~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AG~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~EB*R*IND*30~REF*6P*H3312~LS*2120~NM1*P4*2*AETNA MEDICARE*****PI*H3312~N3*151 FARMINGTON AVENUE~N4*HARTFORD*CT*06156~PER*IC*PROVIDER SERVICES*TE*8002825366~LE*2120~EB*R*IND*30~REF*18*6MM6R34JV64~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*49*311992930~GE*1*311992930~IEA*1*311992930~