Raw X12 — CIN NA06692K

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1118*|*00501*384724365*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1118*724365*X*005010X279A1~ST*270*4365*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*NA06692K~EQ*30~DTP*291*D8*20260914~SE*13*4365~GE*1*724365~IEA*1*384724365~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0718*^*00501*244093130*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071844*244093130*X*005010X279A1~ST*271*244093130*005010X279A1~BHT*0022*11*202609141118000001*20260914*071844~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*TAVAREZ*JOSE*R***MI*NA06692K~N3*3540 EASTCHESTER RD           2~N4*BRONX*NY*10469~DMG*D8*19560705*M~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260101~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*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*8YF0U51VG18~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*244093130~GE*1*244093130~IEA*1*244093130~