Raw X12 — CIN YG67244C

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1914*|*00501*648457754*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1914*457754*X*005010X279A1~ST*270*7754*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*YG67244C~EQ*30~DTP*291*D8*20260814~SE*13*7754~GE*1*457754~IEA*1*648457754~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1514*^*00501*536876430*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151413*536876430*X*005010X279A1~ST*271*536876430*005010X279A1~BHT*0022*11*202608131914000001*20260813*151413~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*MARTIN*DONNA*M***MI*YG67244C~N3*2798 RANDALL AVE              3A~N4*BRONX*NY*10465~DMG*D8*19620820*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260601~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~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~SE*29*536876430~GE*1*536876430~IEA*1*536876430~