Raw X12 — CIN XP72538W

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1033*|*00501*357984438*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1033*984438*X*005010X279A1~ST*270*4438*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*XP72538W~EQ*30~DTP*291*D8*20260806~SE*13*4438~GE*1*984438~IEA*1*357984438~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0633*^*00501*238191630*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*063300*238191630*X*005010X279A1~ST*271*238191630*005010X279A1~BHT*0022*11*202608101033000001*20260810*063300~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*SANTANA CERDA*VANESA*D***MI*XP72538W~N3*383 CRISTOPHER AVE~N4*BROOKLYN*NY*11212~DMG*D8*20101010*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20251201~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 H78~MSG*RECERT MONTH=12~LS*2120~NM1*Y2*2*HEALTH FIRST PHSP INC*****PI*SF~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*88~SE*29*238191630~GE*1*238191630~IEA*1*238191630~