Raw X12 — CIN TT96381W

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*2006*|*00501*305969684*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*2006*969684*X*005010X279A1~ST*270*9684*005010X279A1~BHT*0022*13*202608092006000001*20260809*2006~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*202608092006000001*00000000ND~NM1*IL*1******MI*TT96381W~EQ*30~DTP*291*D8*20260806~SE*13*9684~GE*1*969684~IEA*1*305969684~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1606*^*00501*316667030*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*160605*316667030*X*005010X279A1~ST*271*316667030*005010X279A1~BHT*0022*11*202608092006000001*20260809*160605~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*202608092006000001*00000000ND~NM1*IL*1*KOZLOV*KLAUDIA****MI*TT96381W~N3*35 GORDON ST                  409~N4*STATEN ISLAND*NY*10304~DMG*D8*19410528*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20260601~EB*1*IND*30**MA Eligible~MSG*PD~MSG*60~MSG*CNTY CD=66 523~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*18*6TQ5N67KJ70~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*316667030~GE*1*316667030~IEA*1*316667030~