Raw X12 — CIN ZD22733M

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1919*|*00501*648787121*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1919*787121*X*005010X279A1~ST*270*7121*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*ZD22733M~EQ*30~DTP*291*D8*20260814~SE*13*7121~GE*1*787121~IEA*1*648787121~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1519*^*00501*538311230*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151942*538311230*X*005010X279A1~ST*271*538311230*005010X279A1~BHT*0022*11*202608131919000001*20260813*151942~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*QUINONES*CARMEN****MI*ZD22733M~N3*3135 PARK AVE                 20A~N4*BRONX*NY*10454~DMG*D8*19370727*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*1*IND*30**MA Eligible~MSG*PD~MSG*60~MSG*CNTY CD=66 523~MSG*RECERT MONTH=04~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AG~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~EB*R*IND*30~REF*18*093287042~REF*6P*0~LS*2120~NM1*P4*2*VISION SERVICE PLAN (VSP)*****PI*VSP~N3*PO BOX 997105~N4*SACRAMENTO*CA*958897105~PER*IC*PROVIDER SERVICES*TE*8008777195~LE*2120~EB*R*IND*30~REF*18*3H97EE4QV34~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*51*538311230~GE*1*538311230~IEA*1*538311230~