Raw X12 — CIN WN45503F

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1922*|*00501*648936281*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1922*936281*X*005010X279A1~ST*270*6281*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*WN45503F~EQ*30~DTP*291*D8*20260814~SE*13*6281~GE*1*936281~IEA*1*648936281~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1522*^*00501*541539530*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152211*541539530*X*005010X279A1~ST*271*541539530*005010X279A1~BHT*0022*11*202608131922000001*20260813*152211~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*GABBASOVA*MINSLU****MI*WN45503F~N3*135 ELMIRA LOOP               10D~N4*BROOKLYN*NY*11239~DMG*D8*19531210*F~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~LS*2120~NM1*Y2*2*VILLAGE SENIOR SVC CORP PARTIAL LTC*****PI*VL~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*1*IND*88~EB*R*IND*30~REF*18*8Y53XD9NM92~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*35*541539530~GE*1*541539530~IEA*1*541539530~