Raw X12 — CIN XH40999V

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260809*2006*|*00501*305980697*1*P*:~GS*HS*00ND*EMEDNYREL*20260809*2006*980697*X*005010X279A1~ST*270*0697*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*XH40999V~EQ*30~DTP*291*D8*20260806~SE*13*0697~GE*1*980697~IEA*1*305980697~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260809*1606*^*00501*316673630*0*P*|~GS*HB*EMEDNYREL*00ND*20260809*160616*316673630*X*005010X279A1~ST*271*316673630*005010X279A1~BHT*0022*11*202608092006000001*20260809*160616~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*KRETOWICZ*TERESA****MI*XH40999V~N3*25 BOREUM ST                  3A~N4*BROOKLYN*NY*11206~DMG*D8*19491127*F~DTP*472*D8*20260809~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=02~LS*2120~NM1*Y2*2*ELDERSERVE HEALTH INC MLTCP*****PI*EH~N3*80 W 225TH ST FL 3~N4*BRONX*NY*104637002~PER*IC*PROVIDER SERVICES*TE*8003703600~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H5549~LS*2120~NM1*P4*2*VNS CHOICE MEDICARE*****PI*H5549~N3*1250 BROADWAY  3RD FLOOR~N4*NEW YORK*NY*10001~PER*IC*PROVIDER SERVICES*TE*8665976674~LE*2120~EB*R*IND*30~REF*18*4J71M54KH12~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*44*316673630~GE*1*316673630~IEA*1*316673630~