Raw X12 — CIN ZB88193P

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2005*|*00501*565139055*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2005*139055*X*005010X279A1~ST*270*9055*005010X279A1~BHT*0022*13*202608122005000001*20260812*2005~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*202608122005000001*00000000ND~NM1*IL*1******MI*ZB88193P~EQ*30~DTP*291*D8*20260813~SE*13*9055~GE*1*139055~IEA*1*565139055~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1605*^*00501*533982930*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160534*533982930*X*005010X279A1~ST*271*533982930*005010X279A1~BHT*0022*11*202608122005000001*20260812*160534~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*202608122005000001*00000000ND~NM1*IL*1*WATTSONFORD*FILMA*C***MI*ZB88193P~N3*285      ST JOHNS PLACE PLACE 43~N4*BROOKLYN*NY*11238~DMG*D8*19510705*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H3533~LS*2120~NM1*P4*2*HUMANA HEALTH COMPANY OF NY*****PI*H3533~N3*100 ELWOOD DAVIS ROAD~N4*NORTH SYRACUSE*NY*13212~PER*IC*PROVIDER SERVICES*TE*8005738597~LE*2120~EB*R*IND*30~REF*18*7DV4Q76VJ82~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*44*533982930~GE*1*533982930~IEA*1*533982930~