Raw X12 — CIN UV50468W

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1913*|*00501*648387931*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1913*387931*X*005010X279A1~ST*270*7931*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*UV50468W~EQ*30~DTP*291*D8*20260814~SE*13*7931~GE*1*387931~IEA*1*648387931~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1513*^*00501*536579930*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151303*536579930*X*005010X279A1~ST*271*536579930*005010X279A1~BHT*0022*11*202608131913000001*20260813*151303~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*ROJAS*ANGELA****MI*UV50468W~N3*101 W 118 ST                  2B~N4*NEW YORK*NY*10026~DMG*D8*19510127*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*H9~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*CATHOLIC MANAGED LONG T C PACE INC*****PI*AC~N3*205 LEXINGTON AVE FL~N4*NEW YORK*NY*100166053~PER*IC*PROVIDER SERVICES*TE*6466334702~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*R*IND*30~REF*18*8CM6E71PY86~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*34*536579930~GE*1*536579930~IEA*1*536579930~