Raw X12 — CIN YP97626A

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1926*|*00501*649207087*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1926*207087*X*005010X279A1~ST*270*7087*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*YP97626A~EQ*30~DTP*291*D8*20260814~SE*13*7087~GE*1*207087~IEA*1*649207087~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1526*^*00501*542672030*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152642*542672030*X*005010X279A1~ST*271*542672030*005010X279A1~BHT*0022*11*202608131926000001*20260813*152642~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*MERLO*SONIA****MI*YP97626A~N3*530 W 55TH ST                 6 C~N4*NEW YORK CITY*NY*10019~DMG*D8*19350218*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260301~EB*U*IND*30**ELIGIBLE PCP~MSG*60~MSG*CNTY CD=66 548~MSG*RECERT MONTH=08~EB*B*IND*30***29*0~EB*R*IND*30~REF*18*1C56EW6QR76~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*27*542672030~GE*1*542672030~IEA*1*542672030~