Raw X12 — CIN US97467W

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*0712*|*00501*518764745*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0712*764745*X*005010X279A1~ST*270*4745*005010X279A1~BHT*0022*13*202608120712000001*20260812*0712~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*202608120712000001*00000000ND~NM1*IL*1******MI*US97467W~EQ*30~DTP*291*D8*20260812~SE*13*4745~GE*1*764745~IEA*1*518764745~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*0312*^*00501*172035330*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*031240*172035330*X*005010X279A1~ST*271*172035330*005010X279A1~BHT*0022*11*202608120712000001*20260812*031240~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*202608120712000001*00000000ND~NM1*IL*1******MI*US97467W~DTP*472*D8*20260812~EB*6*IND*30~SE*13*172035330~GE*1*172035330~IEA*1*172035330~