Raw X12 — CIN US97467W

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1029*|*00501*357779958*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1029*779958*X*005010X279A1~ST*270*9958*005010X279A1~BHT*0022*13*202608101029000001*20260810*1029~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*202608101029000001*00000000ND~NM1*IL*1******MI*US97467W~EQ*30~DTP*291*D8*20260806~SE*13*9958~GE*1*779958~IEA*1*357779958~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0629*^*00501*237865830*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062935*237865830*X*005010X279A1~ST*271*237865830*005010X279A1~BHT*0022*11*202608101029000001*20260810*062935~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*202608101029000001*00000000ND~NM1*IL*1******MI*US97467W~DTP*472*D8*20260810~EB*6*IND*30~SE*13*237865830~GE*1*237865830~IEA*1*237865830~