Raw X12 — CIN QB64166M

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260812*2007*|*00501*565278932*1*P*:~GS*HS*00ND*EMEDNYREL*20260812*2007*278932*X*005010X279A1~ST*270*8932*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*QB64166M~EQ*30~DTP*291*D8*20260813~SE*13*8932~GE*1*278932~IEA*1*565278932~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260812*1607*^*00501*534480030*0*P*|~GS*HB*EMEDNYREL*00ND*20260812*160754*534480030*X*005010X279A1~ST*271*534480030*005010X279A1~BHT*0022*11*202608122007000001*20260812*160754~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*TORRES*ANTONIA****MI*QB64166M~N3*264      SOUTH 1ST STREET     4A~N4*BROOKLYN*NY*11211~DMG*D8*19530419*F~DTP*472*D8*20260812~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=04~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*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN  PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*9Y15AA7JM59~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*534480030~GE*1*534480030~IEA*1*534480030~