Raw X12 — CIN XV22707A

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1117*|*00501*384647961*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1117*647961*X*005010X279A1~ST*270*7961*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*XV22707A~EQ*30~DTP*291*D8*20260914~SE*13*7961~GE*1*647961~IEA*1*384647961~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0717*^*00501*243994430*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071728*243994430*X*005010X279A1~ST*271*243994430*005010X279A1~BHT*0022*11*202609141117000001*20260914*071728~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*BAENA*ARIEL****MI*XV22707A~N3*601      WEST 160TH STREET    1C~N4*NEW YORK*NY*10032~DMG*D8*19421227*M~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260501~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*HEALTHFIRST HEALTH PLAN, INC*****PI*MH~N3*100 CHURCH ST FL 18~N4*NEW YORK*NY*100072601~PER*IC*PROVIDER SERVICES*TE*8888011660~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*R*IND*30~REF*6P*H3359~LS*2120~NM1*P4*2*HEALTHFIRST MEDICARE PLAN*****PI*H3359~N3*HEALTHFIRST MEDICARE PLAN  PO BOX 5165~N4*NEW YORK*NY*10274~PER*IC*PROVIDER SERVICES*TE*8882601010~LE*2120~EB*R*IND*30~REF*18*9C99UN9AJ25~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*41*243994430~GE*1*243994430~IEA*1*243994430~