Raw X12 — CIN ZA80502D

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1951*|*00501*305115905*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1951*115905*X*005010X279A1~ST*270*5905*005010X279A1~BHT*0022*13*202608091951000001*20260809*1951~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*202608091951000001*00000000ND~NM1*IL*1******MI*ZA80502D~EQ*30~DTP*291*D8*20260806~SE*13*5905~GE*1*115905~IEA*1*305115905~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1551*^*00501*314940630*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*155151*314940630*X*005010X279A1~ST*271*314940630*005010X279A1~BHT*0022*11*202608091951000001*20260809*155151~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*202608091951000001*00000000ND~NM1*IL*1*LYNBINSKY*NATALYA****MI*ZA80502D~N3*161 CORBIN PLACE              B206~N4*BROOKLYN*NY*11235~DMG*D8*19520526*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260701~EB*U*IND*30**ELIGIBLE PCP~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=06~LS*2120~NM1*Y2*2*ANTHEM HP LLC PARTIAL MLTC*****PI*KX~N3*ONE PENN PLZ FL 35~N4*NEW YORK*NY*101190000~PER*IC*PROVIDER SERVICES*TE*2125635570~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*2HN8C62AR22~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*35*314940630~GE*1*314940630~IEA*1*314940630~