Raw X12 — CIN MY75682S

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*0706*|*00501*518406540*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0706*406540*X*005010X279A1~ST*270*6540*005010X279A1~BHT*0022*13*202608120706000001*20260812*0706~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*202608120706000001*00000000ND~NM1*IL*1******MI*MY75682S~EQ*30~DTP*291*D8*20260812~SE*13*6540~GE*1*406540~IEA*1*518406540~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*0306*^*00501*167478030*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*030642*167478030*X*005010X279A1~ST*271*167478030*005010X279A1~BHT*0022*11*202608120706000001*20260812*030642~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*202608120706000001*00000000ND~NM1*IL*1*CHMYR*YAROSLAVA****MI*MY75682S~N3*2519     EAST 29 ST~N4*BROOKLYN*NY*11235~DMG*D8*19470908*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=05~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*6P*H3312~LS*2120~NM1*P4*2*AETNA MEDICARE*****PI*H3312~N3*151 FARMINGTON AVENUE~N4*HARTFORD*CT*06156~PER*IC*PROVIDER SERVICES*TE*8002825366~LE*2120~EB*R*IND*30~REF*18*6FP2RA9RR12~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*167478030~GE*1*167478030~IEA*1*167478030~