Raw X12 — CIN GU42408X

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2007*|*00501*565235318*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2007*235318*X*005010X279A1~ST*270*5318*005010X279A1~BHT*0022*13*202608122007000001*20260812*2007~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*202608122007000001*00000000ND~NM1*IL*1******MI*GU42408X~EQ*30~DTP*291*D8*20260813~SE*13*5318~GE*1*235318~IEA*1*565235318~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1607*^*00501*534327430*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160710*534327430*X*005010X279A1~ST*271*534327430*005010X279A1~BHT*0022*11*202608122007000001*20260812*160710~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*202608122007000001*00000000ND~NM1*IL*1*SHAW*VEVIAN*G***MI*GU42408X~N3*247 N  FULTON AVENUE~N4*MOUNT VERNON*NY*10552~DMG*D8*19491007*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20251101~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=55~MSG*RECERT MONTH=05~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*H3312~LS*2120~NM1*P4*2*AETNA MEDICARE*****PI*H3312~N3*151 FARMINGTON AVENUE~N4*HARTFORD*CT*06156~PER*IC*PROVIDER SERVICES*TE*8002825366~LE*2120~EB*R*IND*30~REF*18*4GQ1DN1RD23~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*43*534327430~GE*1*534327430~IEA*1*534327430~