Raw X12 — CIN ZH02567Y

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1919*|*00501*648751076*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1919*751076*X*005010X279A1~ST*270*1076*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*ZH02567Y~EQ*30~DTP*291*D8*20260814~SE*13*1076~GE*1*751076~IEA*1*648751076~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1519*^*00501*538129630*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151906*538129630*X*005010X279A1~ST*271*538129630*005010X279A1~BHT*0022*11*202608131919000001*20260813*151906~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*RAMOS*EVELYN****MI*ZH02567Y~N3*149 E 118TH STREET~N4*NEW YORK*NY*10035~DMG*D8*19531110*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*C2~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*ELDERPLAN INC MAP*****PI*YL~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8778916447~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*W*IND*CQ~LS*2120~NM1*Y2*2*BRIGHTPOINT CARE INC*****XX*1346464989~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*COMMUNITY CARE MANAGEMENT PARTNERS*****XX*1366780850~LE*2120~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*3H40XP8GF37~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*53*538129630~GE*1*538129630~IEA*1*538129630~