Raw X12 — CIN XX36726A

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1957*|*00501*305426985*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1957*426985*X*005010X279A1~ST*270*6985*005010X279A1~BHT*0022*13*202608091957000001*20260809*1957~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*202608091957000001*00000000ND~NM1*IL*1******MI*XX36726A~EQ*30~DTP*291*D8*20260806~SE*13*6985~GE*1*426985~IEA*1*305426985~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1557*^*00501*315158030*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*155702*315158030*X*005010X279A1~ST*271*315158030*005010X279A1~BHT*0022*11*202608091957000001*20260809*155702~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*202608091957000001*00000000ND~NM1*IL*1*THOMPSON*AARON*J***MI*XX36726A~N3*1625 FULTON ST                C607~N4*BROOKLYN*NY*11213~DMG*D8*19520117*M~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*VNS CHOICE PARTIAL LTC*****PI*VC~N3*220 E 42ND ST FL 6~N4*NEW YORK*NY*100175831~PER*IC*PROVIDER SERVICES*TE*8667830222~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~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*9NT3VY0KF07~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*315158030~GE*1*315158030~IEA*1*315158030~