Raw X12 — CIN TZ07957X

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1027*|*00501*357622073*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1027*622073*X*005010X279A1~ST*270*2073*005010X279A1~BHT*0022*13*202608101027000001*20260810*1027~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*202608101027000001*00000000ND~NM1*IL*1******MI*TZ07957X~EQ*30~DTP*291*D8*20260806~SE*13*2073~GE*1*622073~IEA*1*357622073~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0626*^*00501*237651330*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062657*237651330*X*005010X279A1~ST*271*237651330*005010X279A1~BHT*0022*11*202608101027000001*20260810*062657~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*202608101027000001*00000000ND~NM1*IL*1*KARAS*HELENA****MI*TZ07957X~N3*609 METRO AVE~N4*BROOKLYN*NY*11211~DMG*D8*19450513*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20251201~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~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*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*4K09RJ6MG14~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*237651330~GE*1*237651330~IEA*1*237651330~