Raw X12 — CIN CD67890D

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260726*1716*|*00501*086213968*1*P*:~GS*HS*00ND*EMEDNYREL*20260726*1716*213968*X*005010X279A1~ST*270*3968*005010X279A1~BHT*0022*13*202607261716000001*20260726*1716~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*202607261716000001*00000000ND~NM1*IL*1******MI*CD67890D~EQ*30~DTP*291*D8*20260701~SE*13*3968~GE*1*213968~IEA*1*086213968~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260726*1316*^*00501*269590630*0*P*|~GS*HB*EMEDNYREL*00ND*20260726*131650*269590630*X*005010X279A1~ST*271*269590630*005010X279A1~BHT*0022*11*202607261716000001*20260726*131650~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*202607261716000001*00000000ND~NM1*IL*1******MI*CD67890D~AAA*N**72*C~DTP*472*D8*20260726~SE*13*269590630~GE*1*269590630~IEA*1*269590630~