Raw X12 — CIN QQ44611K

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1025*|*00501*357534698*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1025*534698*X*005010X279A1~ST*270*4698*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*QQ44611K~EQ*30~DTP*291*D8*20260806~SE*13*4698~GE*1*534698~IEA*1*357534698~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0625*^*00501*237534930*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062530*237534930*X*005010X279A1~ST*271*237534930*005010X279A1~BHT*0022*11*202608101025000001*20260810*062530~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*GOGILCHYN*DMYTRO****MI*QQ44611K~N3*1818 79TH ST                  C5~N4*BROOKLYN*NY*11214~DMG*D8*19590228*M~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20260601~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=12~LS*2120~NM1*Y2*2*ANTHEM HP LLC PARTIAL MLTC*****PI*KX~N3*ONE PENN PLZ FL 35~N4*NEW YORK*NY*101190000~PER*IC*PROVIDER SERVICES*TE*2125635570~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN  PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*7V55JG5MD66~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*44*237534930~GE*1*237534930~IEA*1*237534930~