Raw X12 — CIN ZG03366V

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1117*|*00501*384666980*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1117*666980*X*005010X279A1~ST*270*6980*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*ZG03366V~EQ*30~DTP*291*D8*20260914~SE*13*6980~GE*1*666980~IEA*1*384666980~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0717*^*00501*244021330*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071747*244021330*X*005010X279A1~ST*271*244021330*005010X279A1~BHT*0022*11*202609141117000001*20260914*071747~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*RIVAS*DALILA*E***MI*ZG03366V~N3*347 56TH ST                   3L~N4*BROOKLYN*NY*11220~DMG*D8*19370210*F~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260301~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*6T22UF8RH27~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*244021330~GE*1*244021330~IEA*1*244021330~