Raw X12 — CIN ZP06639F

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*1954*|*00501*564468038*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1954*468038*X*005010X279A1~ST*270*8038*005010X279A1~BHT*0022*13*202608121954000001*20260812*1954~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*202608121954000001*00000000ND~NM1*IL*1******MI*ZP06639F~EQ*30~DTP*291*D8*20260813~SE*13*8038~GE*1*468038~IEA*1*564468038~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1554*^*00501*529541230*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155423*529541230*X*005010X279A1~ST*271*529541230*005010X279A1~BHT*0022*11*202608121954000001*20260812*155423~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*202608121954000001*00000000ND~NM1*IL*1*CRUZ*NELSON****MI*ZP06639F~N3*159-161 EAST 102 STREET       1B~N4*NEW YORK*NY*10029~DMG*D8*19560205*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=02~LS*2120~NM1*Y2*2*ANTHEM HP LLC PARTIAL MLTC*****PI*KX~N3*ONE PENN PLZ FL 35~N4*NEW YORK*NY*101190000~PER*IC*PROVIDER SERVICES*TE*2125635570~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H0423~LS*2120~NM1*P4*2*METROPLUS HEALTH PLAN, INC.*****PI*H0423~N3*160 WATER STREET~N4*NEW YORK*NY*10038~PER*IC*PROVIDER SERVICES*TE*8669860356~LE*2120~EB*R*IND*30~REF*18*2YP5VU0JY99~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*43*529541230~GE*1*529541230~IEA*1*529541230~