Raw X12 — CIN MY75682S

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1023*|*00501*357422569*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1023*422569*X*005010X279A1~ST*270*2569*005010X279A1~BHT*0022*13*202608101023000001*20260810*1023~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*202608101023000001*00000000ND~NM1*IL*1******MI*MY75682S~EQ*30~DTP*291*D8*20260806~SE*13*2569~GE*1*422569~IEA*1*357422569~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0623*^*00501*237347730*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062338*237347730*X*005010X279A1~ST*271*237347730*005010X279A1~BHT*0022*11*202608101023000001*20260810*062338~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*202608101023000001*00000000ND~NM1*IL*1*CHMYR*YAROSLAVA****MI*MY75682S~N3*2519     EAST 29 ST~N4*BROOKLYN*NY*11235~DMG*D8*19470908*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=05~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~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*6FP2RA9RR12~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*237347730~GE*1*237347730~IEA*1*237347730~