Raw X12 — CIN PT97740V

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*1951*|*00501*564288855*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1951*288855*X*005010X279A1~ST*270*8855*005010X279A1~BHT*0022*13*202608121951000001*20260812*1951~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*202608121951000001*00000000ND~NM1*IL*1******MI*PT97740V~EQ*30~DTP*291*D8*20260813~SE*13*8855~GE*1*288855~IEA*1*564288855~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1551*^*00501*528771130*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155124*528771130*X*005010X279A1~ST*271*528771130*005010X279A1~BHT*0022*11*202608121951000001*20260812*155124~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*202608121951000001*00000000ND~NM1*IL*1*AGORDOME*VERA****MI*PT97740V~N3*2110      WESTBURY CT         5e~N4*BROOKLYN*NY*11225~DMG*D8*19830131*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260601~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*H9~MSG*PD~MSG*CNTY CD=66 066~MSG*RECERT MONTH=12~LS*2120~NM1*Y2*2*ELDERPLAN INC HOMEFIRST PARTIAL LTC*****PI*ED~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8777711119~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*W*IND*CQ~LS*2120~NM1*Y2*2*NATIONAL ASSOCIATION ON DRUG ABUSE*****XX*1295006526~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*COORDINATED BEHAVIORAL CARE INC*****XX*1730451071~LE*2120~SE*42*528771130~GE*1*528771130~IEA*1*528771130~