Raw X12 — CIN MA82925P

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*1958*|*00501*305518078*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*1958*518078*X*005010X279A1~ST*270*8078*005010X279A1~BHT*0022*13*202608091958000001*20260809*1958~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*202608091958000001*00000000ND~NM1*IL*1******MI*MA82925P~EQ*30~DTP*291*D8*20260806~SE*13*8078~GE*1*518078~IEA*1*305518078~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1558*^*00501*315212930*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*155833*315212930*X*005010X279A1~ST*271*315212930*005010X279A1~BHT*0022*11*202608091958000001*20260809*155833~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*202608091958000001*00000000ND~NM1*IL*1*ZADOROJNIUCWERNE*NATALIA****MI*MA82925P~N3*2029 2 AVENUE                 19G~N4*NEW YORK*NY*10029~DMG*D8*19530922*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20251001~EB*1*IND*30**Community Coverage w/CBLTC~MSG*CNTY CD=66 525~MSG*RECERT MONTH=03~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*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*8EH0K81UX43~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*49*315212930~GE*1*315212930~IEA*1*315212930~