Raw X12 — CIN VR74918Z

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1926*|*00501*649165939*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1926*165939*X*005010X279A1~ST*270*5939*005010X279A1~BHT*0022*13*202608131926000001*20260813*1926~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*202608131926000001*00000000ND~NM1*IL*1******MI*VR74918Z~EQ*30~DTP*291*D8*20260814~SE*13*5939~GE*1*165939~IEA*1*649165939~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1526*^*00501*542497530*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152601*542497530*X*005010X279A1~ST*271*542497530*005010X279A1~BHT*0022*11*202608131926000001*20260813*152601~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*202608131926000001*00000000ND~NM1*IL*1*WINSTON*CARL****MI*VR74918Z~N3*170 TAPSCOTT STREET           2B~N4*BROOKLYN*NY*11212~DMG*D8*19560106*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260601~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~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*6P*H5549~LS*2120~NM1*P4*2*VNS CHOICE MEDICARE*****PI*H5549~N3*1250 BROADWAY  3RD FLOOR~N4*NEW YORK*NY*10001~PER*IC*PROVIDER SERVICES*TE*8665976674~LE*2120~EB*R*IND*30~REF*18*2J54DQ6AP84~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*542497530~GE*1*542497530~IEA*1*542497530~