Raw X12 — CIN YZ75423H

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1117*|*00501*384669983*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1117*669983*X*005010X279A1~ST*270*9983*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*YZ75423H~EQ*30~DTP*291*D8*20260914~SE*13*9983~GE*1*669983~IEA*1*384669983~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0717*^*00501*244025730*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071750*244025730*X*005010X279A1~ST*271*244025730*005010X279A1~BHT*0022*11*202609141117000001*20260914*071750~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*ROY*DELORES****MI*YZ75423H~N3*50 LEGION STREET              5-A~N4*BROOKLYN*NY*11212~DMG*D8*19491107*F~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260901~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~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*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*7GW5YX6FY94~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*244025730~GE*1*244025730~IEA*1*244025730~