Raw X12 — CIN VF17894Q

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1915*|*00501*648534063*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1915*534063*X*005010X279A1~ST*270*4063*005010X279A1~BHT*0022*13*202608131915000001*20260813*1915~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*202608131915000001*00000000ND~NM1*IL*1******MI*VF17894Q~EQ*30~DTP*291*D8*20260814~SE*13*4063~GE*1*534063~IEA*1*648534063~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1515*^*00501*537206530*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151529*537206530*X*005010X279A1~ST*271*537206530*005010X279A1~BHT*0022*11*202608131915000001*20260813*151529~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*202608131915000001*00000000ND~NM1*IL*1*POWELL*MICHELLE*V***MI*VF17894Q~N3*724 E 224TH ST                BSMT~N4*BRONX*NY*10466~DMG*D8*19710930*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20251201~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 523~MSG*RECERT MONTH=11~LS*2120~NM1*Y2*2*ELDERSERVE HEALTH INC MLTCP*****PI*EH~N3*80 W 225TH ST FL 3~N4*BRONX*NY*104637002~PER*IC*PROVIDER SERVICES*TE*8003703600~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*6HW0NQ3RM25~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*44*537206530~GE*1*537206530~IEA*1*537206530~