Raw X12 — CIN WR47245S

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1921*|*00501*648877221*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1921*877221*X*005010X279A1~ST*270*7221*005010X279A1~BHT*0022*13*202608131921000001*20260813*1921~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*202608131921000001*00000000ND~NM1*IL*1******MI*WR47245S~EQ*30~DTP*291*D8*20260814~SE*13*7221~GE*1*877221~IEA*1*648877221~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1521*^*00501*541095630*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152112*541095630*X*005010X279A1~ST*271*541095630*005010X279A1~BHT*0022*11*202608131921000001*20260813*152112~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*202608131921000001*00000000ND~NM1*IL*1******MI*WR47245S~DTP*472*D8*20260813~EB*6*IND*30~SE*13*541095630~GE*1*541095630~IEA*1*541095630~