Raw X12 — CIN VE75586M

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1949*|*00501*304943449*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1949*943449*X*005010X279A1~ST*270*3449*005010X279A1~BHT*0022*13*202608091949000001*20260809*1949~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*202608091949000001*00000000ND~NM1*IL*1******MI*VE75586M~EQ*30~DTP*291*D8*20260806~SE*13*3449~GE*1*943449~IEA*1*304943449~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1548*^*00501*312037330*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154859*312037330*X*005010X279A1~ST*271*312037330*005010X279A1~BHT*0022*11*202608091949000001*20260809*154859~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*202608091949000001*00000000ND~NM1*IL*1*ISAKOVA*SHUSHANA****MI*VE75586M~N3*2741 EAST 28 TH ST            3B~N4*BROOKLYN*NY*11235~DMG*D8*19420203*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*1*IND*30**MA Eligible~MSG*PD~MSG*60~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*18*9H14VN5YX90~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*312037330~GE*1*312037330~IEA*1*312037330~