Raw X12 — CIN XP30648G

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1918*|*00501*648734059*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1918*734059*X*005010X279A1~ST*270*4059*005010X279A1~BHT*0022*13*202608131918000001*20260813*1918~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*202608131918000001*00000000ND~NM1*IL*1******MI*XP30648G~EQ*30~DTP*291*D8*20260814~SE*13*4059~GE*1*734059~IEA*1*648734059~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1518*^*00501*538053030*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151849*538053030*X*005010X279A1~ST*271*538053030*005010X279A1~BHT*0022*11*202608131918000001*20260813*151849~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*202608131918000001*00000000ND~NM1*IL*1*BRUCE*FLORINE****MI*XP30648G~N3*237      NASSAU STREET        6K~N4*BROOKLYN*NY*11201~DMG*D8*19501128*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=05~LS*2120~NM1*Y2*2*METROPLUS PARTIAL CAP MLTC*****PI*MP~N3*50 WATER ST FL 7~N4*NEW YORK*NY*100046014~PER*IC*PROVIDER SERVICES*TE*2129088569~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*9HX0CU3CH43~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*36*538053030~GE*1*538053030~IEA*1*538053030~