Raw X12 — CIN UV02234Z

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2006*|*00501*565176135*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2006*176135*X*005010X279A1~ST*270*6135*005010X279A1~BHT*0022*13*202608122006000001*20260812*2006~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*202608122006000001*00000000ND~NM1*IL*1******MI*UV02234Z~EQ*30~DTP*291*D8*20260813~SE*13*6135~GE*1*176135~IEA*1*565176135~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1606*^*00501*534112330*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160611*534112330*X*005010X279A1~ST*271*534112330*005010X279A1~BHT*0022*11*202608122006000001*20260812*160611~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*202608122006000001*00000000ND~NM1*IL*1*ZIMMERMAN*JUDITH*C***MI*UV02234Z~N3*141 W 73 STREET~N4*NEW YORK*NY*10023~DMG*D8*19390127*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260701~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=08~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~EB*R*IND*30~REF*6P*H3418~LS*2120~NM1*P4*2*AARP MEDICARE ADVANTAGE MOSAIC CHOI*****PI*H3418~N3*PO BOX 31362~N4*SALT LAKE CITY*UT*84131~PER*IC*PROVIDER SERVICES*TE*1800643484~LE*2120~EB*R*IND*30~REF*18*6E89MN9FC40~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*534112330~GE*1*534112330~IEA*1*534112330~