Raw X12 — CIN KX95645S

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2003*|*00501*564980611*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2003*980611*X*005010X279A1~ST*270*0611*005010X279A1~BHT*0022*13*202608122003000001*20260812*2003~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*202608122003000001*00000000ND~NM1*IL*1******MI*KX95645S~EQ*30~DTP*291*D8*20260813~SE*13*0611~GE*1*980611~IEA*1*564980611~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1602*^*00501*533414930*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160256*533414930*X*005010X279A1~ST*271*533414930*005010X279A1~BHT*0022*11*202608122003000001*20260812*160256~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*202608122003000001*00000000ND~NM1*IL*1*RODRIGUEZ*RAFAELA****MI*KX95645S~N3*505      62ND STREET          D3~N4*BROOKLYN*NY*11220~DMG*D8*19491024*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20251201~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=05~LS*2120~NM1*Y2*2*ELDERPLAN INC MAP*****PI*YL~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8778916447~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~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*8HD2F22RT25~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*533414930~GE*1*533414930~IEA*1*533414930~