Raw X12 — CIN TW04830R

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1118*|*00501*384697922*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1118*697922*X*005010X279A1~ST*270*7922*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*TW04830R~EQ*30~DTP*291*D8*20260914~SE*13*7922~GE*1*697922~IEA*1*384697922~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0718*^*00501*244059930*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071818*244059930*X*005010X279A1~ST*271*244059930*005010X279A1~BHT*0022*11*202609141118000001*20260914*071818~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*CIRNIGLIARO*GEORGINA****MI*TW04830R~N3*125      WEST 31ST STREET     15E~N4*NEW YORK*NY*10001~DMG*D8*19420524*F~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260501~EB*1*IND*30**Community Coverage w/CBLTC~MSG*PD~MSG*60~MSG*CNTY CD=66 546~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*2P80YP8MQ48~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*51*244059930~GE*1*244059930~IEA*1*244059930~