Raw X12 — CIN PX96762W

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1926*|*00501*649173950*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1926*173950*X*005010X279A1~ST*270*3950*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*PX96762W~EQ*30~DTP*291*D8*20260814~SE*13*3950~GE*1*173950~IEA*1*649173950~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1526*^*00501*542533730*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152609*542533730*X*005010X279A1~ST*271*542533730*005010X279A1~BHT*0022*11*202608131926000001*20260813*152609~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*SOW*HADYA****MI*PX96762W~N3*710      E 138TH ST           1~N4*BRONX*NY*10454~DMG*D8*19640101*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*A1~MSG*A2~MSG*CF~MSG*PD~MSG*CNTY CD=66 523~MSG*RECERT MONTH=10~EB*B*IND*30***29*0~EB*W*IND*CQ~LS*2120~NM1*Y2*2*ESSEN MEDICAL ASSOCIATES PC*****XX*1366418709~LE*2120~EB*W*IND*CQ~LS*2120~NM1*Y2*2*SRH CHN LEAD HEALTH HOME LLC*****XX*1750053948~LE*2120~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*9WV9RD3MR18~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*46*542533730~GE*1*542533730~IEA*1*542533730~