Raw X12 — CIN MP35488M

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1119*|*00501*384757979*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1119*757979*X*005010X279A1~ST*270*7979*005010X279A1~BHT*0022*13*202609141119000001*20260914*1119~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*202609141119000001*00000000ND~NM1*IL*1******MI*MP35488M~EQ*30~DTP*291*D8*20260914~SE*13*7979~GE*1*757979~IEA*1*384757979~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0719*^*00501*244139830*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071918*244139830*X*005010X279A1~ST*271*244139830*005010X279A1~BHT*0022*11*202609141119000001*20260914*071918~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*202609141119000001*00000000ND~NM1*IL*1*LEON*MADELINE****MI*MP35488M~N3*265      CHERRY  STREET       22K~N4*NEW YORK*NY*10002~DMG*D8*19470804*F~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20251101~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*PD~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~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~EB*R*IND*30~REF*18*3FE7NH8DN32~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*36*244139830~GE*1*244139830~IEA*1*244139830~