Raw X12 — CIN XU42466C

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1919*|*00501*648748290*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1919*748290*X*005010X279A1~ST*270*8290*005010X279A1~BHT*0022*13*202608131919000001*20260813*1919~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*202608131919000001*00000000ND~NM1*IL*1******MI*XU42466C~EQ*30~DTP*291*D8*20260814~SE*13*8290~GE*1*748290~IEA*1*648748290~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1519*^*00501*538116230*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151903*538116230*X*005010X279A1~ST*271*538116230*005010X279A1~BHT*0022*11*202608131919000001*20260813*151903~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*202608131919000001*00000000ND~NM1*IL*1*JOHN*THOMAS*A***MI*XU42466C~N3*776      LINDEN BLVD~N4*BROOKLYN*NY*11203~DMG*D8*19480831*M~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~LS*2120~NM1*Y2*2*HAMASPIK CHOICE INC PARTIAL MLTC*****PI*HC~N3*775 N MAIN ST~N4*SPRING VALLEY*NY*109778968~PER*IC*PROVIDER SERVICES*TE*8455030570~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN  PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*3N04PU7RD71~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*538116230~GE*1*538116230~IEA*1*538116230~