Raw X12 — CIN GV09925Z

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1035*|*00501*358146378*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1035*146378*X*005010X279A1~ST*270*6378*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*GV09925Z~EQ*30~DTP*291*D8*20260806~SE*13*6378~GE*1*146378~IEA*1*358146378~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0635*^*00501*238361830*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*063542*238361830*X*005010X279A1~ST*271*238361830*005010X279A1~BHT*0022*11*202608101035000001*20260810*063542~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*WITCZAK*BARBARA****MI*GV09925Z~N3*581 CHAMBERLIN ST 5P~N4*EAST MEADOW*NY*11554~DMG*D8*19500413*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20260601~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=28~MSG*RECERT MONTH=01~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*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*2Y56TC4CM63~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*238361830~GE*1*238361830~IEA*1*238361830~