Raw X12 — CIN VE73779B

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1925*|*00501*649120473*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1925*120473*X*005010X279A1~ST*270*0473*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*VE73779B~EQ*30~DTP*291*D8*20260814~SE*13*0473~GE*1*120473~IEA*1*649120473~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1525*^*00501*542313030*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152516*542313030*X*005010X279A1~ST*271*542313030*005010X279A1~BHT*0022*11*202608131925000001*20260813*152516~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*GURALNIK*YEFIM****MI*VE73779B~N3*2682 W 2ND STREET             2A~N4*BKLYN*NY*11223~DMG*D8*19480409*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=11~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*7GP4E55PC61~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*35*542313030~GE*1*542313030~IEA*1*542313030~