Raw X12 — CIN MK96547E

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1913*|*00501*648425715*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1913*425715*X*005010X279A1~ST*270*5715*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*MK96547E~EQ*30~DTP*291*D8*20260814~SE*13*5715~GE*1*425715~IEA*1*648425715~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1513*^*00501*536741830*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151341*536741830*X*005010X279A1~ST*271*536741830*005010X279A1~BHT*0022*11*202608131913000001*20260813*151341~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*DIAZ*ANGELA****MI*MK96547E~N3*4568     MANHATTAN COLLEGE PKW2F~N4*BRONX*NY*10471~DMG*D8*19560531*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 508~MSG*RECERT MONTH=04~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*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN  PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*9YH9H81XG29~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*536741830~GE*1*536741830~IEA*1*536741830~