Raw X12 — CIN ZQ12573A

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1036*|*00501*358172690*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1036*172690*X*005010X279A1~ST*270*2690*005010X279A1~BHT*0022*13*202608101036000001*20260810*1036~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*202608101036000001*00000000ND~NM1*IL*1******MI*ZQ12573A~EQ*30~DTP*291*D8*20260806~SE*13*2690~GE*1*172690~IEA*1*358172690~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0636*^*00501*238389530*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*063608*238389530*X*005010X279A1~ST*271*238389530*005010X279A1~BHT*0022*11*202608101036000001*20260810*063608~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*202608101036000001*00000000ND~NM1*IL*1*ZALTSMAN*ROSALIA****MI*ZQ12573A~N3*2612 WEST ST                  2B~N4*BROOKLYN*NY*11223~DMG*D8*19400802*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=01~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*7DX6FF4PN56~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*36*238389530~GE*1*238389530~IEA*1*238389530~