Raw X12 — CIN XT92821S

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1926*|*00501*649205828*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1926*205828*X*005010X279A1~ST*270*5828*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*XT92821S~EQ*30~DTP*291*D8*20260814~SE*13*5828~GE*1*205828~IEA*1*649205828~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1526*^*00501*542666130*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152641*542666130*X*005010X279A1~ST*271*542666130*005010X279A1~BHT*0022*11*202608131926000001*20260813*152641~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*MELIKIANTS*ARTOUR****MI*XT92821S~N3*2820     BRAGG ST             1~N4*BROOKLYN*NY*11235~DMG*D8*19641208*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20250901~EB*1*IND*30**MA Eligible~MSG*81~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=05~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~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~SE*36*542666130~GE*1*542666130~IEA*1*542666130~