Raw X12 — CIN KK64994H

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1920*|*00501*648820160*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1920*820160*X*005010X279A1~ST*270*0160*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*KK64994H~EQ*30~DTP*291*D8*20260814~SE*13*0160~GE*1*820160~IEA*1*648820160~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1520*^*00501*538448230*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152015*538448230*X*005010X279A1~ST*271*538448230*005010X279A1~BHT*0022*11*202608131920000001*20260813*152015~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*CHEHEBAR*NINA****MI*KK64994H~N3*1938     EAST 7TH STREET~N4*BKLYN*NY*11223~DMG*D8*19340701*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20251201~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*4RE6NC3MM81~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*34*538448230~GE*1*538448230~IEA*1*538448230~