Raw X12 — CIN WH08570X

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1028*|*00501*357702122*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1028*702122*X*005010X279A1~ST*270*2122*005010X279A1~BHT*0022*13*202608101028000001*20260810*1028~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*202608101028000001*00000000ND~NM1*IL*1******MI*WH08570X~EQ*30~DTP*291*D8*20260806~SE*13*2122~GE*1*702122~IEA*1*357702122~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0628*^*00501*237766630*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062817*237766630*X*005010X279A1~ST*271*237766630*005010X279A1~BHT*0022*11*202608101028000001*20260810*062817~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*202608101028000001*00000000ND~NM1*IL*1*KRAVETS*LYUBOV****MI*WH08570X~N3*1120 BRIGHTON BEACH AVE       5T~N4*BROOKLYN*NY*11235~DMG*D8*19600326*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=04~LS*2120~NM1*Y2*2*VNS CHOICE PARTIAL LTC*****PI*VC~N3*220 E 42ND ST FL 6~N4*NEW YORK*NY*100175831~PER*IC*PROVIDER SERVICES*TE*8667830222~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*8VN6UV0XK56~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*36*237766630~GE*1*237766630~IEA*1*237766630~