Raw X12 — CIN ZJ26053W

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1913*|*00501*648409692*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1913*409692*X*005010X279A1~ST*270*9692*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*ZJ26053W~EQ*30~DTP*291*D8*20260814~SE*13*9692~GE*1*409692~IEA*1*648409692~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1513*^*00501*536674830*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151325*536674830*X*005010X279A1~ST*271*536674830*005010X279A1~BHT*0022*11*202608131913000001*20260813*151325~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*CENTINO*VIDAIL****MI*ZJ26053W~N3*283      W 147TH   ST         1A~N4*NEW YORK*NY*10039~DMG*D8*19550830*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*PD~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=09~LS*2120~NM1*Y2*2*ELDERPLAN INC MAP*****PI*YL~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8778916447~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*W*IND*CQ~LS*2120~NM1*Y2*2*TREMONT HELPS INC*****XX*1205460581~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*SRH CHN LEAD HEALTH HOME LLC*****XX*1750053948~LE*2120~EB*R*IND*30~REF*6P*H3347~LS*2120~NM1*P4*2*ELDERPLAN*****PI*H3347~N3*ELDERPLAN  INC   745 64TH STREET~N4*BROOKLYN*NY*11220~PER*IC*PROVIDER SERVICES*TE*8003533765~LE*2120~EB*R*IND*30~REF*18*6XE5AW6KV78~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*54*536674830~GE*1*536674830~IEA*1*536674830~