Raw X12 — CIN YG32581G

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1926*|*00501*649177953*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1926*177953*X*005010X279A1~ST*270*7953*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*YG32581G~EQ*30~DTP*291*D8*20260814~SE*13*7953~GE*1*177953~IEA*1*649177953~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1526*^*00501*542550430*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152613*542550430*X*005010X279A1~ST*271*542550430*005010X279A1~BHT*0022*11*202608131926000001*20260813*152613~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*RODRIGUEZ*ISIDRO*G***MI*YG32581G~N3*965 TINTON AVENUE             2C~N4*BRONX*NY*10456~DMG*D8*19360515*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*1*IND*30**Community Coverage w/CBLTC~MSG*PD~MSG*CNTY CD=66 523~MSG*RECERT MONTH=04~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*33~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AG~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~EB*R*IND*30~REF*6P*H2168~LS*2120~NM1*P4*2*VILLAGECAREMAX MEDICARE TOTAL ADVAN*****PI*H2168~N3*P O  BOX 5426~N4*HAUPPAUGE*NY*117885426~PER*IC*PROVIDER SERVICES*TE*8004696292~LE*2120~EB*R*IND*30~REF*18*9D52FE4GU10~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*50*542550430~GE*1*542550430~IEA*1*542550430~