Raw X12 — CIN WT01608X

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1920*|*00501*648801135*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1920*801135*X*005010X279A1~ST*270*1135*005010X279A1~BHT*0022*13*202608131920000001*20260813*1920~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*202608131920000001*00000000ND~NM1*IL*1******MI*WT01608X~EQ*30~DTP*291*D8*20260814~SE*13*1135~GE*1*801135~IEA*1*648801135~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1519*^*00501*538371030*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*151957*538371030*X*005010X279A1~ST*271*538371030*005010X279A1~BHT*0022*11*202608131920000001*20260813*151957~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*202608131920000001*00000000ND~NM1*IL*1*WEBSTER*ALICE****MI*WT01608X~N3*553      58TH STREET          V~N4*BROOKLYN*NY*11220~DMG*D8*19350503*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*1*IND*30**Community Coverage w/CBLTC~MSG*60~MSG*S1~MSG*CNTY CD=66 523~MSG*RECERT MONTH=08~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*K4001105001~REF*6P*1100190~LS*2120~NM1*P4*2*MONTEFIORE*****PI*MONT~N3*200 CORPORATE DRIVE~N4*YONKERS*NY*107016806~LE*2120~EB*R*IND*30~REF*18*7AA9DK2WQ31~LS*2120~NM1*P4*2*MEDICARE AB~LE*2120~SE*50*538371030~GE*1*538371030~IEA*1*538371030~