Raw X12 — CIN WC96597T

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*0718*|*00501*519133403*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*0718*133403*X*005010X279A1~ST*270*3403*005010X279A1~BHT*0022*13*202608120718000001*20260812*0718~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*202608120718000001*00000000ND~NM1*IL*1******MI*WC96597T~EQ*30~DTP*291*D8*20260812~SE*13*3403~GE*1*133403~IEA*1*519133403~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*0318*^*00501*176406030*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*031849*176406030*X*005010X279A1~ST*271*176406030*005010X279A1~BHT*0022*11*202608120718000001*20260812*031849~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*202608120718000001*00000000ND~NM1*IL*1*WINKLER*HALINA****MI*WC96597T~N3*1145     36 STREET~N4*BROOKLYN*NY*11218~DMG*D8*19501021*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=11~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*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN  PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*4R92TW6QJ85~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*176406030~GE*1*176406030~IEA*1*176406030~