Raw X12 — CIN RZ52101T

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1118*|*00501*384712347*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1118*712347*X*005010X279A1~ST*270*2347*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*RZ52101T~EQ*30~DTP*291*D8*20260914~SE*13*2347~GE*1*712347~IEA*1*384712347~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0718*^*00501*244077630*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071832*244077630*X*005010X279A1~ST*271*244077630*005010X279A1~BHT*0022*11*202609141118000001*20260914*071832~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*ALVAREZ*JARIELY*M***MI*RZ52101T~N3*225 WORTMAN AVENUE            4B~N4*BROOKLYN*NY*11207~DMG*D8*20040402*F~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260401~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~LS*2120~NM1*Y2*2*VILLAGE SENIOR SVC CORP PARTIAL LTC*****PI*VL~N3*112 CHARLES ST FL 2~N4*NEW YORK*NY*100142653~PER*IC*PROVIDER SERVICES*TE*8557692500~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~SE*29*244077630~GE*1*244077630~IEA*1*244077630~