Raw X12 — CIN RC62456R

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2003*|*00501*564992624*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2003*992624*X*005010X279A1~ST*270*2624*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*RC62456R~EQ*30~DTP*291*D8*20260813~SE*13*2624~GE*1*992624~IEA*1*564992624~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1603*^*00501*533459430*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160308*533459430*X*005010X279A1~ST*271*533459430*005010X279A1~BHT*0022*11*202608122003000001*20260812*160308~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*ROJAS*EULOGIA****MI*RC62456R~N3*190 WEST 170 STREET           5K~N4*BRONX*NY*10452~DMG*D8*19480313*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260701~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*ELDERPLAN INC HOMEFIRST PARTIAL LTC*****PI*ED~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8777711119~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H5549~LS*2120~NM1*P4*2*VNS CHOICE MEDICARE*****PI*H5549~N3*1250 BROADWAY  3RD FLOOR~N4*NEW YORK*NY*10001~PER*IC*PROVIDER SERVICES*TE*8665976674~LE*2120~EB*R*IND*30~REF*18*4EY6DG9TN40~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*533459430~GE*1*533459430~IEA*1*533459430~