Raw X12 — CIN RN60600S

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1118*|*00501*384686912*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1118*686912*X*005010X279A1~ST*270*6912*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*RN60600S~EQ*30~DTP*291*D8*20260914~SE*13*6912~GE*1*686912~IEA*1*384686912~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0718*^*00501*244048830*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071807*244048830*X*005010X279A1~ST*271*244048830*005010X279A1~BHT*0022*11*202609141118000001*20260914*071807~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*DAMBROSIA*FLAVIA****MI*RN60600S~N3*812      LOGAN AVE~N4*BRONX*NY*10465~DMG*D8*19440925*F~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20251101~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*VNS CHOICE PARTIAL LTC*****PI*VC~N3*220 E 42ND ST FL 6~N4*NEW YORK*NY*100175831~PER*IC*PROVIDER SERVICES*TE*8667830222~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*18*6EC7NM8KJ56~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*35*244048830~GE*1*244048830~IEA*1*244048830~