Raw X12 — CIN TD08989J

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1911*|*00501*648278905*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1911*278905*X*005010X279A1~ST*270*8905*005010X279A1~BHT*0022*13*202608131911000001*20260813*1911~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*202608131911000001*00000000ND~NM1*IL*1******MI*TD08989J~EQ*30~DTP*291*D8*20260814~SE*13*8905~GE*1*278905~IEA*1*648278905~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1511*^*00501*536143230*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151114*536143230*X*005010X279A1~ST*271*536143230*005010X279A1~BHT*0022*11*202608131911000001*20260813*151114~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*202608131911000001*00000000ND~NM1*IL*1*LEVY*YACOB****MI*TD08989J~N3*2224     EAST 63 RD STREET~N4*BROOKLYN*NY*11234~DMG*D8*19500321*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20251101~EB*U*IND*30**ELIGIBLE PCP~MSG*60~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~EB*B*IND*30***29*0~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*3FT5R17UE85~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*36*536143230~GE*1*536143230~IEA*1*536143230~