Raw X12 — CIN ZW04420V

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*1952*|*00501*564332194*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1952*332194*X*005010X279A1~ST*270*2194*005010X279A1~BHT*0022*13*202608121952000001*20260812*1952~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*202608121952000001*00000000ND~NM1*IL*1******MI*ZW04420V~EQ*30~DTP*291*D8*20260813~SE*13*2194~GE*1*332194~IEA*1*564332194~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1552*^*00501*529040830*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155207*529040830*X*005010X279A1~ST*271*529040830*005010X279A1~BHT*0022*11*202608121952000001*20260812*155207~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*202608121952000001*00000000ND~NM1*IL*1*BARNETT*PETER****MI*ZW04420V~N3*499       PENNSYLVANIA AVE    1A~N4*BROOKLYN*NY*11207~DMG*D8*19430612*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260801~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 073~LS*2120~NM1*Y2*2*VILLAGE SENIOR SERVICES CORP MAP*****PI*VM~N3*112 CHARLES ST FL 2~N4*NEW YORK*NY*100142653~PER*IC*PROVIDER SERVICES*TE*8557692500~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*R*IND*30~REF*6P*H2168~LS*2120~NM1*P4*2*VILLAGECAREMAX MEDICARE TOTAL ADVAN*****PI*H2168~N3*P O  BOX 5426~N4*HAUPPAUGE*NY*117885426~PER*IC*PROVIDER SERVICES*TE*8004696292~LE*2120~EB*R*IND*30~REF*18*3FM6EU0AP49~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*40*529040830~GE*1*529040830~IEA*1*529040830~