Raw X12 — CIN WH91323P

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1025*|*00501*357527990*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1025*527990*X*005010X279A1~ST*270*7990*005010X279A1~BHT*0022*13*202608101025000001*20260810*1025~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*202608101025000001*00000000ND~NM1*IL*1******MI*WH91323P~EQ*30~DTP*291*D8*20260806~SE*13*7990~GE*1*527990~IEA*1*357527990~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0625*^*00501*237523430*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062523*237523430*X*005010X279A1~ST*271*237523430*005010X279A1~BHT*0022*11*202608101025000001*20260810*062523~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*202608101025000001*00000000ND~NM1*IL*1*GEYSTRINA*YELENA****MI*WH91323P~N3*1599 W 10TH ST                4E~N4*BROOKLYN*NY*11204~DMG*D8*19361014*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20260601~EB*1*IND*30**MA Eligible~MSG*CF~MSG*PD~MSG*60~MSG*NH~MSG*CNTY CD=66 508~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*4T38NV9WV10~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*237523430~GE*1*237523430~IEA*1*237523430~