Raw X12 — CIN AR99186R

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1117*|*00501*384659974*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1117*659974*X*005010X279A1~ST*270*9974*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*AR99186R~EQ*30~DTP*291*D8*20260914~SE*13*9974~GE*1*659974~IEA*1*384659974~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0717*^*00501*244011530*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071740*244011530*X*005010X279A1~ST*271*244011530*005010X279A1~BHT*0022*11*202609141117000001*20260914*071740~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*PEREZ*CATHY****MI*AR99186R~N3*24 HUNT PLACE~N4*WHITE PLAINS*NY*10606~DMG*D8*19511128*F~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20251001~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=55~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*ELDERPLAN INC HOMEFIRST PARTIAL LTC*****PI*ED~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8777711119~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*8CW6UM6WV62~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*244011530~GE*1*244011530~IEA*1*244011530~