Raw X12 — CIN QG01300W

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1949*|*00501*304948457*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1949*948457*X*005010X279A1~ST*270*8457*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*QG01300W~EQ*30~DTP*291*D8*20260806~SE*13*8457~GE*1*948457~IEA*1*304948457~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1549*^*00501*312041430*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*154904*312041430*X*005010X279A1~ST*271*312041430*005010X279A1~BHT*0022*11*202608091949000001*20260809*154904~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*IVANOVYCH*OKSANA****MI*QG01300W~N3*1425 PENNSYLVANIYA AVENUE     5G~N4*BROOKLYN*NY*11239~DMG*D8*19620922*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=07~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*18*5H55V48MT40~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*35*312041430~GE*1*312041430~IEA*1*312041430~