Raw X12 — CIN RT78214S

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1120*|*00501*384831044*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1120*831044*X*005010X279A1~ST*270*1044*005010X279A1~BHT*0022*13*202609141120000001*20260914*1120~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*202609141120000001*00000000ND~NM1*IL*1******MI*RT78214S~EQ*30~DTP*291*D8*20260914~SE*13*1044~GE*1*831044~IEA*1*384831044~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0720*^*00501*244442030*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*072031*244442030*X*005010X279A1~ST*271*244442030*005010X279A1~BHT*0022*11*202609141120000001*20260914*072031~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*202609141120000001*00000000ND~NM1*IL*1*POLANCODEJESUS*ROMAN****MI*RT78214S~N3*572      EAST 138TH ST        5B~N4*BRONX*NY*10454~DMG*D8*19570319*M~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20260201~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*ELDERPLAN INC MAP*****PI*YL~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8778916447~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*R*IND*30~REF*6P*H3347~LS*2120~NM1*P4*2*ELDERPLAN*****PI*H3347~N3*ELDERPLAN  INC   745 64TH STREET~N4*BROOKLYN*NY*11220~PER*IC*PROVIDER SERVICES*TE*8003533765~LE*2120~EB*R*IND*30~REF*18*9E09ME2TM30~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*42*244442030~GE*1*244442030~IEA*1*244442030~