Raw X12 — CIN ZG88644S

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1035*|*00501*358100331*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1035*100331*X*005010X279A1~ST*270*0331*005010X279A1~BHT*0022*13*202608101035000001*20260810*1035~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*202608101035000001*00000000ND~NM1*IL*1******MI*ZG88644S~EQ*30~DTP*291*D8*20260806~SE*13*0331~GE*1*100331~IEA*1*358100331~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0634*^*00501*238316130*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*063456*238316130*X*005010X279A1~ST*271*238316130*005010X279A1~BHT*0022*11*202608101035000001*20260810*063456~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*202608101035000001*00000000ND~NM1*IL*1*TSVILIKHOVSKY*GALINA****MI*ZG88644S~N3*2684 WEST STREET              6-E~N4*BROOKLYN*NY*11223~DMG*D8*19510922*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*ELDERSERVE HEALTH INC MLTCP*****PI*EH~N3*80 W 225TH ST FL 3~N4*BRONX*NY*104637002~PER*IC*PROVIDER SERVICES*TE*8003703600~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*4G88FH6UM46~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*33*238316130~GE*1*238316130~IEA*1*238316130~