Raw X12 — CIN TT55687P

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260813*1927*|*00501*649228707*1*P*:~GS*HS*00ND*EMEDNYREL*20260813*1927*228707*X*005010X279A1~ST*270*8707*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*TT55687P~EQ*30~DTP*291*D8*20260814~SE*13*8707~GE*1*228707~IEA*1*649228707~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260813*1527*^*00501*542766030*0*P*|~GS*HB*EMEDNYREL*00ND*20260813*152704*542766030*X*005010X279A1~ST*271*542766030*005010X279A1~BHT*0022*11*202608131927000001*20260813*152704~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*VALDEZ*NICOLE****MI*TT55687P~N3*260      AUDUBON AVE          22A~N4*NEW YORK*NY*10033~DMG*D8*19930408*F~DTP*472*D8*20260813~DTP*346*D8*20260801~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*H9~MSG*PD~MSG*CNTY CD=66 508~MSG*RECERT MONTH=09~LS*2120~NM1*Y2*2*VNS CHOICE PLUS M/M MAP*****PI*YN~N3*220 E 42ND ST FL 6~N4*NEW YORK*NY*100175831~PER*IC*PROVIDER SERVICES*TE*8669867691~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*R*IND*30~REF*6P*H5549~LS*2120~NM1*P4*2*VNS CHOICE MEDICARE*****PI*H5549~N3*1250 BROADWAY  3RD FLOOR~N4*NEW YORK*NY*10001~PER*IC*PROVIDER SERVICES*TE*8665976674~LE*2120~EB*R*IND*30~REF*18*4Q57V66CX42~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*542766030~GE*1*542766030~IEA*1*542766030~