Raw X12 — CIN WX40047J

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1117*|*00501*384664978*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1117*664978*X*005010X279A1~ST*270*4978*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*WX40047J~EQ*30~DTP*291*D8*20260914~SE*13*4978~GE*1*664978~IEA*1*384664978~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0717*^*00501*244018230*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071745*244018230*X*005010X279A1~ST*271*244018230*005010X279A1~BHT*0022*11*202609141117000001*20260914*071745~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*BALDERA*CRISTINO****MI*WX40047J~N3*365 59TH ST~N4*BROOKLYN*NY*11220~DMG*D8*19440724*M~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~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*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*1VE7U96GP43~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*43*244018230~GE*1*244018230~IEA*1*244018230~