Raw X12 — CIN UQ36359V

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1921*|*00501*648900245*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1921*900245*X*005010X279A1~ST*270*0245*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*UQ36359V~EQ*30~DTP*291*D8*20260814~SE*13*0245~GE*1*900245~IEA*1*648900245~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1521*^*00501*541289830*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152135*541289830*X*005010X279A1~ST*271*541289830*005010X279A1~BHT*0022*11*202608131921000001*20260813*152135~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*COSTIGAN*JEFFREY****MI*UQ36359V~N3*65-47 160TH STREET            4C~N4*FLUSHING*NY*11365~DMG*D8*19650412*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260601~EB*1*IND*30**Community Coverage w/CBLTC~MSG*PD~MSG*81~MSG*CNTY CD=66 508~MSG*RECERT MONTH=12~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*33~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*7Q63PU0YV71~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*541289830~GE*1*541289830~IEA*1*541289830~