Raw X12 — CIN YG24164U

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*1957*|*00501*564664261*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*1957*664261*X*005010X279A1~ST*270*4261*005010X279A1~BHT*0022*13*202608121957000001*20260812*1957~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*202608121957000001*00000000ND~NM1*IL*1******MI*YG24164U~EQ*30~DTP*291*D8*20260813~SE*13*4261~GE*1*664261~IEA*1*564664261~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1557*^*00501*530274430*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*155739*530274430*X*005010X279A1~ST*271*530274430*005010X279A1~BHT*0022*11*202608121957000001*20260812*155739~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*202608121957000001*00000000ND~NM1*IL*1*HENRY*CLIFFORD*V***MI*YG24164U~N3*824 ALBANY AVE                B3~N4*BROOKLYN*NY*11203~DMG*D8*19541025*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*1*IND*30**MA Eligible~MSG*CNTY CD=66 5A6~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*33~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AG~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~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*3NJ7HV9XN46~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*48*530274430~GE*1*530274430~IEA*1*530274430~