Raw X12 — CIN SW72200M

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1118*|*00501*384682425*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1118*682425*X*005010X279A1~ST*270*2425*005010X279A1~BHT*0022*13*202609141118000001*20260914*1118~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*202609141118000001*00000000ND~NM1*IL*1******MI*SW72200M~EQ*30~DTP*291*D8*20260914~SE*13*2425~GE*1*682425~IEA*1*384682425~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0718*^*00501*244045430*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071802*244045430*X*005010X279A1~ST*271*244045430*005010X279A1~BHT*0022*11*202609141118000001*20260914*071802~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*202609141118000001*00000000ND~NM1*IL*1*ABAD*ESPERANZA****MI*SW72200M~N3*206      W 105TH ST           4~N4*NY*NY*10025~DMG*D8*19431204*F~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260401~EB*1*IND*30**Community Coverage w/CBLTC~MSG*CF~MSG*PD~MSG*60~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~EB*B*IND*30***29*0~EB*1*IND*1~EB*1*IND*4~EB*1*IND*5~EB*1*IND*33~EB*1*IND*35~EB*1*IND*47~EB*1*IND*48~EB*1*IND*50~EB*1*IND*86~EB*1*IND*88~EB*1*IND*98~EB*1*IND*AG~EB*1*IND*AL~EB*1*IND*MH~EB*1*IND*UC~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*7AA6XK4FX67~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*52*244045430~GE*1*244045430~IEA*1*244045430~