Raw X12 — CIN ZZ30113A

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1031*|*00501*357880082*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1031*880082*X*005010X279A1~ST*270*0082*005010X279A1~BHT*0022*13*202608101031000001*20260810*1031~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*202608101031000001*00000000ND~NM1*IL*1******MI*ZZ30113A~EQ*30~DTP*291*D8*20260806~SE*13*0082~GE*1*880082~IEA*1*357880082~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0631*^*00501*238054230*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*063115*238054230*X*005010X279A1~ST*271*238054230*005010X279A1~BHT*0022*11*202608101031000001*20260810*063115~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*202608101031000001*00000000ND~NM1*IL*1*PERALTA*MARTINA****MI*ZZ30113A~N3*34       POST AVE             45~N4*NEW YORK*NY*10034~DMG*D8*19550115*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 505~MSG*RECERT MONTH=01~LS*2120~NM1*Y2*2*HEALTHFIRST HEALTH PLAN, INC*****PI*MH~N3*100 CHURCH ST FL 18~N4*NEW YORK*NY*100072601~PER*IC*PROVIDER SERVICES*TE*8888011660~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~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*4U01MN2EP29~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*238054230~GE*1*238054230~IEA*1*238054230~