Raw X12 — CIN TU46105U

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1117*|*00501*384668982*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1117*668982*X*005010X279A1~ST*270*8982*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*TU46105U~EQ*30~DTP*291*D8*20260914~SE*13*8982~GE*1*668982~IEA*1*384668982~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0717*^*00501*244023330*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071749*244023330*X*005010X279A1~ST*271*244023330*005010X279A1~BHT*0022*11*202609141117000001*20260914*071749~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*IRIZARRY*DELIA****MI*TU46105U~N3*133 40   ROOSEVELT AVE        10A~N4*FLUSHING*NY*11354~DMG*D8*19501230*F~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20251001~EB*U*IND*30**ELIGIBLE PCP~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*SENIOR WHOLE HEALTH OF NY PARTIAL*****PI*SW~N3*15 METROTECH CTR FL~N4*BROOKLYN*NY*112013826~PER*IC*PROVIDER SERVICES*TE*8773530185~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H3387~LS*2120~NM1*P4*2*UNITEDHEALTHCARE DUAL COMPLETE*****PI*H3387~N3*P O BOX 917~N4*NEW YORK*NY*10269~PER*IC*PROVIDER SERVICES*TE*8005144912~LE*2120~EB*R*IND*30~REF*18*1HH5C49TP56~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*42*244023330~GE*1*244023330~IEA*1*244023330~