Raw X12 — CIN ZU00846X

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1923*|*00501*648984510*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1923*984510*X*005010X279A1~ST*270*4510*005010X279A1~BHT*0022*13*202608131923000001*20260813*1923~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*202608131923000001*00000000ND~NM1*IL*1******MI*ZU00846X~EQ*30~DTP*291*D8*20260814~SE*13*4510~GE*1*984510~IEA*1*648984510~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1523*^*00501*541736630*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152300*541736630*X*005010X279A1~ST*271*541736630*005010X279A1~BHT*0022*11*202608131923000001*20260813*152300~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*202608131923000001*00000000ND~NM1*IL*1*RAMIREZ*ZOILA****MI*ZU00846X~N3*287 N 8TH STREET              1L~N4*BROOKLYN*NY*11211~DMG*D8*19470115*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 523~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*6P*H0423~LS*2120~NM1*P4*2*METROPLUS HEALTH PLAN, INC.*****PI*H0423~N3*160 WATER STREET~N4*NEW YORK*NY*10038~PER*IC*PROVIDER SERVICES*TE*8669860356~LE*2120~EB*R*IND*30~REF*18*1W11T20RK90~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*541736630~GE*1*541736630~IEA*1*541736630~