Raw X12 — CIN KX24874Z

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1920*|*00501*648804913*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1920*804913*X*005010X279A1~ST*270*4913*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*KX24874Z~EQ*30~DTP*291*D8*20260814~SE*13*4913~GE*1*804913~IEA*1*648804913~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1520*^*00501*538385530*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152000*538385530*X*005010X279A1~ST*271*538385530*005010X279A1~BHT*0022*11*202608131920000001*20260813*152000~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******MI*KX24874Z~DTP*472*D8*20260813~EB*6*IND*30**No Coverage - Excess Income, Resources Verified~SE*13*538385530~GE*1*538385530~IEA*1*538385530~