Raw X12 — CIN PK14160F

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2005*|*00501*565145786*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2005*145786*X*005010X279A1~ST*270*5786*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*PK14160F~EQ*30~DTP*291*D8*20260813~SE*13*5786~GE*1*145786~IEA*1*565145786~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1605*^*00501*534005730*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160541*534005730*X*005010X279A1~ST*271*534005730*005010X279A1~BHT*0022*11*202608122005000001*20260812*160541~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*WILKINS*RASHAN****MI*PK14160F~N3*11        PORT RICHMOND AVE~N4*STATEN ISLAND*NY*10302~DMG*D8*19770311*M~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*1*IND*30**MA Eligible~MSG*H9~MSG*CNTY CD=66 099~MSG*RECERT MONTH=12~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~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~SE*36*534005730~GE*1*534005730~IEA*1*534005730~