Raw X12 — CIN XK34399Y

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260810*1037*|*00501*358235988*1*P*:~GS*HS*00ND*EMEDNYREL*20260810*1037*235988*X*005010X279A1~ST*270*5988*005010X279A1~BHT*0022*13*202608101037000001*20260810*1037~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*202608101037000001*00000000ND~NM1*IL*1******MI*XK34399Y~EQ*30~DTP*291*D8*20260806~SE*13*5988~GE*1*235988~IEA*1*358235988~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260810*0637*^*00501*238451030*0*P*|~GS*HB*EMEDNYREL*00ND*20260810*063711*238451030*X*005010X279A1~ST*271*238451030*005010X279A1~BHT*0022*11*202608101037000001*20260810*063711~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*202608101037000001*00000000ND~NM1*IL*1*SHNAYDER*ANNA****MI*XK34399Y~N3*8800 SHORE FRONT PKWY         40~N4*ROCKAWAY BCH*NY*11693~DMG*D8*19560610*F~DTP*472*D8*20260810~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=07~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*H4868~LS*2120~NM1*P4*2*WELLCARE*****PI*H4868~N3*PO BOX 25885~N4*TAMPA*FL*33622~PER*IC*PROVIDER SERVICES*TE*8002785155~LE*2120~EB*R*IND*30~REF*18*3M81TQ0KK05~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*238451030~GE*1*238451030~IEA*1*238451030~