Raw X12 — CIN ZW68847H

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*1955*|*00501*564528093*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1955*528093*X*005010X279A1~ST*270*8093*005010X279A1~BHT*0022*13*202608121955000001*20260812*1955~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*202608121955000001*00000000ND~NM1*IL*1******MI*ZW68847H~EQ*30~DTP*291*D8*20260813~SE*13*8093~GE*1*528093~IEA*1*564528093~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1555*^*00501*529767730*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155523*529767730*X*005010X279A1~ST*271*529767730*005010X279A1~BHT*0022*11*202608121955000001*20260812*155523~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*202608121955000001*00000000ND~NM1*IL*1*DURANT*LASHAWN****MI*ZW68847H~N3*275      W 140TH ST           7B~N4*NEW YORK*NY*10030~DMG*D8*19750430*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 023~MSG*RECERT MONTH=12~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~SE*30*529767730~GE*1*529767730~IEA*1*529767730~