Raw X12 — CIN QJ91395U

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1119*|*00501*384787005*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1119*787005*X*005010X279A1~ST*270*7005*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*QJ91395U~EQ*30~DTP*291*D8*20260914~SE*13*7005~GE*1*787005~IEA*1*384787005~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0719*^*00501*244178330*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*071947*244178330*X*005010X279A1~ST*271*244178330*005010X279A1~BHT*0022*11*202609141119000001*20260914*071947~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*YAGUACHI*MOISES****MI*QJ91395U~N3*2627 18TH STREET~N4*ASTORIA*NY*11102~DMG*D8*19840428*M~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260101~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*H9~MSG*PD~MSG*CNTY CD=66 523~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*VILLAGE SENIOR SERVICES CORP MAP*****PI*VM~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*R*IND*30~REF*6P*H2168~LS*2120~NM1*P4*2*VILLAGECAREMAX MEDICARE TOTAL ADVAN*****PI*H2168~N3*P O  BOX 5426~N4*HAUPPAUGE*NY*117885426~PER*IC*PROVIDER SERVICES*TE*8004696292~LE*2120~EB*R*IND*30~REF*18*5YV0H23NR90~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*244178330~GE*1*244178330~IEA*1*244178330~