Raw X12 — CIN QH97501Q

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1927*|*00501*649225587*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1927*225587*X*005010X279A1~ST*270*5587*005010X279A1~BHT*0022*13*202608131927000001*20260813*1927~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*202608131927000001*00000000ND~NM1*IL*1******MI*QH97501Q~EQ*30~DTP*291*D8*20260814~SE*13*5587~GE*1*225587~IEA*1*649225587~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1527*^*00501*542751430*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152701*542751430*X*005010X279A1~ST*271*542751430*005010X279A1~BHT*0022*11*202608131927000001*20260813*152701~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*202608131927000001*00000000ND~NM1*IL*1*TAMUKEY*DUDLEYJ****MI*QH97501Q~N3*306      MACON ST~N4*BROOKLYN*NY*11216~DMG*D8*19490418*M~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=01~LS*2120~NM1*Y2*2*VNS CHOICE PARTIAL LTC*****PI*VC~N3*220 E 42ND ST FL 6~N4*NEW YORK*NY*100175831~PER*IC*PROVIDER SERVICES*TE*8667830222~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H3312~LS*2120~NM1*P4*2*AETNA MEDICARE*****PI*H3312~N3*151 FARMINGTON AVENUE~N4*HARTFORD*CT*06156~PER*IC*PROVIDER SERVICES*TE*8002825366~LE*2120~EB*R*IND*30~REF*18*5R66MN3VF59~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*44*542751430~GE*1*542751430~IEA*1*542751430~