Raw X12 — CIN VE88636N

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1914*|*00501*648497800*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1914*497800*X*005010X279A1~ST*270*7800*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*VE88636N~EQ*30~DTP*291*D8*20260814~SE*13*7800~GE*1*497800~IEA*1*648497800~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1514*^*00501*537043830*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151453*537043830*X*005010X279A1~ST*271*537043830*005010X279A1~BHT*0022*11*202608131914000001*20260813*151453~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*STANKOVA*HALINA****MI*VE88636N~N3*3091     BRIGHTON 3RD ST      3D~N4*BROOKLYN*NY*11235~DMG*D8*19521201*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260601~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*PD~MSG*CNTY CD=66 521~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*W*IND*CQ~LS*2120~NM1*Y2*2*JEMCARE LLC*****XX*1265926216~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*COMMUNITY CARE MANAGEMENT PARTNERS*****XX*1366780850~LE*2120~EB*R*IND*30~REF*18*2G10CW8UU35~LS*2120~NM1*P4*2*MEDICARE BD~LE*2120~SE*45*537043830~GE*1*537043830~IEA*1*537043830~