Raw X12 — CIN YA60011D

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2000*|*00501*564805153*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2000*805153*X*005010X279A1~ST*270*5153*005010X279A1~BHT*0022*13*202608122000000001*20260812*2000~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*202608122000000001*00000000ND~NM1*IL*1******MI*YA60011D~EQ*30~DTP*291*D8*20260813~SE*13*5153~GE*1*805153~IEA*1*564805153~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1600*^*00501*530798230*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160000*530798230*X*005010X279A1~ST*271*530798230*005010X279A1~BHT*0022*11*202608122000000001*20260812*160000~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*202608122000000001*00000000ND~NM1*IL*1*MELENDEZ*DAYSEAN****MI*YA60011D~N3*166      HALE AVENUE          2~N4*BROOKLYN*NY*11208~DMG*D8*20080410*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260201~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*95~MSG*CNTY CD=66 580~MSG*RECERT MONTH=01~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~SE*32*530798230~GE*1*530798230~IEA*1*530798230~