Raw X12 — CIN TB96344A

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1925*|*00501*649113463*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1925*113463*X*005010X279A1~ST*270*3463*005010X279A1~BHT*0022*13*202608131925000001*20260813*1925~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*202608131925000001*00000000ND~NM1*IL*1******MI*TB96344A~EQ*30~DTP*291*D8*20260814~SE*13*3463~GE*1*113463~IEA*1*649113463~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1525*^*00501*542282930*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152509*542282930*X*005010X279A1~ST*271*542282930*005010X279A1~BHT*0022*11*202608131925000001*20260813*152509~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*202608131925000001*00000000ND~NM1*IL*1******MI*TB96344A~DTP*472*D8*20260813~EB*6*IND*30~SE*13*542282930~GE*1*542282930~IEA*1*542282930~