Raw X12 — CIN UX89812W

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1913*|*00501*648381652*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1913*381652*X*005010X279A1~ST*270*1652*005010X279A1~BHT*0022*13*202608131913000001*20260813*1913~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*202608131913000001*00000000ND~NM1*IL*1******MI*UX89812W~EQ*30~DTP*291*D8*20260814~SE*13*1652~GE*1*381652~IEA*1*648381652~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1512*^*00501*536553130*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151257*536553130*X*005010X279A1~ST*271*536553130*005010X279A1~BHT*0022*11*202608131913000001*20260813*151257~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*202608131913000001*00000000ND~NM1*IL*1******MI*UX89812W~DTP*472*D8*20260813~EB*6*IND*30~SE*13*536553130~GE*1*536553130~IEA*1*536553130~