Raw X12 — CIN XY57771H

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*1952*|*00501*564346247*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1952*346247*X*005010X279A1~ST*270*6247*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*XY57771H~EQ*30~DTP*291*D8*20260813~SE*13*6247~GE*1*346247~IEA*1*564346247~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1552*^*00501*529095530*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155221*529095530*X*005010X279A1~ST*271*529095530*005010X279A1~BHT*0022*11*202608121952000001*20260812*155221~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*BELTRAN*ANGELA*L***MI*XY57771H~N3*141 W 73RD ST                 8L~N4*NEW YORK*NY*10023~DMG*D8*19450802*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*ELDERPLAN INC MAP*****PI*YL~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8778916447~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*R*IND*30~REF*6P*H3347~LS*2120~NM1*P4*2*ELDERPLAN*****PI*H3347~N3*ELDERPLAN  INC   745 64TH STREET~N4*BROOKLYN*NY*11220~PER*IC*PROVIDER SERVICES*TE*8003533765~LE*2120~EB*R*IND*30~REF*18*2UY8P95PY56~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*41*529095530~GE*1*529095530~IEA*1*529095530~