Raw X12 — CIN NJ67937S

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*1956*|*00501*564589163*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1956*589163*X*005010X279A1~ST*270*9163*005010X279A1~BHT*0022*13*202608121956000001*20260812*1956~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*202608121956000001*00000000ND~NM1*IL*1******MI*NJ67937S~EQ*30~DTP*291*D8*20260813~SE*13*9163~GE*1*589163~IEA*1*564589163~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1556*^*00501*529999530*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155624*529999530*X*005010X279A1~ST*271*529999530*005010X279A1~BHT*0022*11*202608121956000001*20260812*155624~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*202608121956000001*00000000ND~NM1*IL*1*GARCIA*MILAGROS****MI*NJ67937S~N3*2250 WEST 11TH STREET         1A~N4*BROOKLYN*NY*11223~DMG*D8*19440110*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*VILLAGE SENIOR SVC CORP PARTIAL LTC*****PI*VL~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*1*IND*88~EB*R*IND*30~REF*18*2Y63G00HQ87~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*35*529999530~GE*1*529999530~IEA*1*529999530~