Raw X12 — CIN XN96534K

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1033*|*00501*357982210*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1033*982210*X*005010X279A1~ST*270*2210*005010X279A1~BHT*0022*13*202608101033000001*20260810*1033~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*202608101033000001*00000000ND~NM1*IL*1******MI*XN96534K~EQ*30~DTP*291*D8*20260806~SE*13*2210~GE*1*982210~IEA*1*357982210~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0632*^*00501*238189330*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*063257*238189330*X*005010X279A1~ST*271*238189330*005010X279A1~BHT*0022*11*202608101033000001*20260810*063257~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*202608101033000001*00000000ND~NM1*IL*1*SANON*MARIE****MI*XN96534K~N3*1263     E 73RD ST            2FL~N4*BROOKLYN*NY*11234~DMG*D8*19480426*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=08~LS*2120~NM1*Y2*2*VILLAGE SENIOR SVC CORP PARTIAL LTC*****PI*VL~N3*112 CHARLES ST FL 2~N4*NEW YORK*NY*100142653~PER*IC*PROVIDER SERVICES*TE*8557692500~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H3330~LS*2120~NM1*P4*2*HIP MEDICARE HMO*****PI*H3330~N3*55 WATER STREET  55 WATER STREET~N4*NEW YORK CITY*NY*10041~PER*IC*PROVIDER SERVICES*TE*8004478255~LE*2120~EB*R*IND*30~REF*18*3UC1TG6JE03~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*44*238189330~GE*1*238189330~IEA*1*238189330~