Raw X12 — CIN SX41864B

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1914*|*00501*648450748*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1914*450748*X*005010X279A1~ST*270*0748*005010X279A1~BHT*0022*13*202608131914000001*20260813*1914~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*202608131914000001*00000000ND~NM1*IL*1******MI*SX41864B~EQ*30~DTP*291*D8*20260814~SE*13*0748~GE*1*450748~IEA*1*648450748~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1514*^*00501*536846230*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151406*536846230*X*005010X279A1~ST*271*536846230*005010X279A1~BHT*0022*11*202608131914000001*20260813*151406~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*202608131914000001*00000000ND~NM1*IL*1*LEGER*EDIKSON****MI*SX41864B~N3*476 CHRISTIAN HERALD ROAD~N4*VALLEY COTTAGE*NY*10969~DMG*D8*19450905*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=06~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*18*112722491~REF*6P*HFPP01~LS*2120~NM1*P4*2*DAVIS VISION*****PI*90~N3*PO BOX 1501~N4*LATHAM*NY*121108001~PER*IC*PROVIDER SERVICES*TE*8009995431~LE*2120~EB*R*IND*30~REF*18*4UK8UH0XW64~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*536846230~GE*1*536846230~IEA*1*536846230~