Raw X12 — CIN VH50829C

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1913*|*00501*648410689*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1913*410689*X*005010X279A1~ST*270*0689*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*VH50829C~EQ*30~DTP*291*D8*20260814~SE*13*0689~GE*1*410689~IEA*1*648410689~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1513*^*00501*536679130*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151326*536679130*X*005010X279A1~ST*271*536679130*005010X279A1~BHT*0022*11*202608131913000001*20260813*151326~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*CESPEDES*JOSEFINA****MI*VH50829C~N3*2254 CHATTERTON AVE           2FL~N4*BRONX*NY*10472~DMG*D8*19520419*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~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*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*8FV4WM1HN65~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*41*536679130~GE*1*536679130~IEA*1*536679130~