Raw X12 — CIN XT43426X

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1913*|*00501*648419986*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1913*419986*X*005010X279A1~ST*270*9986*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*XT43426X~EQ*30~DTP*291*D8*20260814~SE*13*9986~GE*1*419986~IEA*1*648419986~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1513*^*00501*536719430*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151335*536719430*X*005010X279A1~ST*271*536719430*005010X279A1~BHT*0022*11*202608131913000001*20260813*151335~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*DAVID*NORMA****MI*XT43426X~N3*1350     WEBSTER AVE          16D~N4*BRONX*NY*10456~DMG*D8*19620106*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 548~MSG*RECERT MONTH=07~LS*2120~NM1*Y2*2*ELDERPLAN INC HOMEFIRST PARTIAL LTC*****PI*ED~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8777711119~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H5549~LS*2120~NM1*P4*2*VNS CHOICE MEDICARE*****PI*H5549~N3*1250 BROADWAY  3RD FLOOR~N4*NEW YORK*NY*10001~PER*IC*PROVIDER SERVICES*TE*8665976674~LE*2120~EB*R*IND*30~REF*18*2VX1H43WJ14~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*536719430~GE*1*536719430~IEA*1*536719430~