Raw X12 — CIN RQ69964K

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1029*|*00501*357780959*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1029*780959*X*005010X279A1~ST*270*0959*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*RQ69964K~EQ*30~DTP*291*D8*20260806~SE*13*0959~GE*1*780959~IEA*1*357780959~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0629*^*00501*237867130*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*062936*237867130*X*005010X279A1~ST*271*237867130*005010X279A1~BHT*0022*11*202608101029000001*20260810*062936~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*MARTIN*NICHOLAS*L***MI*RQ69964K~N3*2903     FARRAGUT RD          2 FL~N4*BROOKLYN*NY*11210~DMG*D8*19470205*M~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20260201~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=08~LS*2120~NM1*Y2*2*VNS CHOICE PLUS M/M MAP*****PI*YN~N3*220 E 42ND ST FL 6~N4*NEW YORK*NY*100175831~PER*IC*PROVIDER SERVICES*TE*8669867691~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*R*IND*30~REF*6P*H5549~LS*2120~NM1*P4*2*VNS CHOICE MEDICARE*****PI*H5549~N3*1250 BROADWAY  3RD FLOOR~N4*NEW YORK*NY*10001~PER*IC*PROVIDER SERVICES*TE*8665976674~LE*2120~EB*R*IND*30~REF*18*5W34K97WR65~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*237867130~GE*1*237867130~IEA*1*237867130~