Raw X12 — CIN RK10314T

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1117*|*00501*384634948*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1117*634948*X*005010X279A1~ST*270*4948*005010X279A1~BHT*0022*13*202609141117000001*20260914*1117~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*202609141117000001*00000000ND~NM1*IL*1******MI*RK10314T~EQ*30~DTP*291*D8*20260914~SE*13*4948~GE*1*634948~IEA*1*384634948~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0717*^*00501*243976030*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071715*243976030*X*005010X279A1~ST*271*243976030*005010X279A1~BHT*0022*11*202609141117000001*20260914*071715~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*202609141117000001*00000000ND~NM1*IL*1*ORTIZ*ALBERTO****MI*RK10314T~N3*347 56TH ST                   3L~N4*BROOKLYN*NY*11220~DMG*D8*19300618*M~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260801~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~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*2D32AG3CG17~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*44*243976030~GE*1*243976030~IEA*1*243976030~