Raw X12 — CIN NJ27631V

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1119*|*00501*384760391*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1119*760391*X*005010X279A1~ST*270*0391*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*NJ27631V~EQ*30~DTP*291*D8*20260914~SE*13*0391~GE*1*760391~IEA*1*384760391~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0719*^*00501*244144530*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071920*244144530*X*005010X279A1~ST*271*244144530*005010X279A1~BHT*0022*11*202609141119000001*20260914*071920~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*ARAGON  DE  OLANO*MARGARITA****MI*NJ27631V~N3*14605    HAWTHORNE AVE        2 FL~N4*FLUSHING*NY*11355~DMG*D8*19590608*F~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20251001~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 523~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*HEALTHFIRST HEALTH PLAN, INC*****PI*MH~N3*100 CHURCH ST FL 18~N4*NEW YORK*NY*100072601~PER*IC*PROVIDER SERVICES*TE*8888011660~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~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*5JD2AK4VK09~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*244144530~GE*1*244144530~IEA*1*244144530~