Raw X12 — CIN KW88937T

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*0714*|*00501*518865860*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0714*865860*X*005010X279A1~ST*270*5860*005010X279A1~BHT*0022*13*202608120714000001*20260812*0714~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*202608120714000001*00000000ND~NM1*IL*1******MI*KW88937T~EQ*30~DTP*291*D8*20260812~SE*13*5860~GE*1*865860~IEA*1*518865860~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*0314*^*00501*175333530*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*031422*175333530*X*005010X279A1~ST*271*175333530*005010X279A1~BHT*0022*11*202608120714000001*20260812*031422~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*202608120714000001*00000000ND~NM1*IL*1*PERALTA*KIMBERLY****MI*KW88937T~N3*1KATIUSKA JARAMA FOR          4R~N4*BROOKLYN*NY*11237~DMG*D8*20141219*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*PD~MSG*CNTY CD=66 500~LS*2120~NM1*Y2*2*HEALTH FIRST PHSP INC*****PI*SF~N3*100 CHURCH ST FL 18~N4*NEW YORK*NY*100072601~PER*IC*PROVIDER SERVICES*TE*8888011660~LE*2120~EB*B*IND*30***29*0~EB*1*IND*88~EB*W*IND*CQ~LS*2120~NM1*Y2*2*JEMCARE LLC*****XX*1265926216~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*THE COLLABORATIVE FOR CHILDREN AND*****XX*1417349622~LE*2120~SE*38*175333530~GE*1*175333530~IEA*1*175333530~