Raw X12 — CIN ZE66426G

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1922*|*00501*648928301*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1922*928301*X*005010X279A1~ST*270*8301*005010X279A1~BHT*0022*13*202608131922000001*20260813*1922~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*202608131922000001*00000000ND~NM1*IL*1******MI*ZE66426G~EQ*30~DTP*291*D8*20260814~SE*13*8301~GE*1*928301~IEA*1*648928301~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1522*^*00501*541509630*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152203*541509630*X*005010X279A1~ST*271*541509630*005010X279A1~BHT*0022*11*202608131922000001*20260813*152203~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*202608131922000001*00000000ND~NM1*IL*1*DUMENGSR*ANGEL*L***MI*ZE66426G~N3*265      LOGAN STREET         604~N4*BROOKLYN*NY*11203~DMG*D8*19500905*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=05~LS*2120~NM1*Y2*2*VILLAGE SENIOR SERVICES CORP MAP*****PI*VM~N3*112 CHARLES ST FL 2~N4*NEW YORK*NY*100142653~PER*IC*PROVIDER SERVICES*TE*8557692500~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*R*IND*30~REF*18*15988951~REF*6P*10METRO038~LS*2120~NM1*P4*2*HEALTH INS PLAN OF GREATER NY*****PI*HA~N3*PO BOX 2858~N4*NEW YORK*NY*101162858~PER*IC*PROVIDER SERVICES*TE*8004478255~LE*2120~EB*R*IND*30~REF*6P*H2168~LS*2120~NM1*P4*2*VILLAGECAREMAX MEDICARE TOTAL ADVAN*****PI*H2168~N3*P O  BOX 5426~N4*HAUPPAUGE*NY*117885426~PER*IC*PROVIDER SERVICES*TE*8004696292~LE*2120~EB*R*IND*30~REF*18*9DN8H27RN59~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*52*541509630~GE*1*541509630~IEA*1*541509630~