Raw X12 — CIN XS60193B

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*0713*|*00501*518801126*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0713*801126*X*005010X279A1~ST*270*1126*005010X279A1~BHT*0022*13*202608120713000001*20260812*0713~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*202608120713000001*00000000ND~NM1*IL*1******MI*XS60193B~EQ*30~DTP*291*D8*20260812~SE*13*1126~GE*1*801126~IEA*1*518801126~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*0313*^*00501*173070330*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*031316*173070330*X*005010X279A1~ST*271*173070330*005010X279A1~BHT*0022*11*202608120713000001*20260812*031316~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*202608120713000001*00000000ND~NM1*IL*1*MORDUKHAEV*ABO****MI*XS60193B~N3*99 56    65TH AVENUE~N4*REGO PARK*NY*11374~DMG*D8*19391214*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20251201~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=11~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*2GW8N29GP56~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*35*173070330~GE*1*173070330~IEA*1*173070330~