Raw X12 — CIN TY43277Z

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1120*|*00501*384839052*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1120*839052*X*005010X279A1~ST*270*9052*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*TY43277Z~EQ*30~DTP*291*D8*20260914~SE*13*9052~GE*1*839052~IEA*1*384839052~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0720*^*00501*244752630*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*072039*244752630*X*005010X279A1~ST*271*244752630*005010X279A1~BHT*0022*11*202609141120000001*20260914*072039~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*MYERS*RUTH****MI*TY43277Z~N3*20       VANDALIA AVENUE      19C~N4*BROOKLYN*NY*11239~DMG*D8*19320913*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*6P*H3330~LS*2120~NM1*P4*2*HIP MEDICARE HMO*****PI*H3330~N3*55 WATER STREET  55 WATER STREET~N4*NEW YORK CITY*NY*10041~PER*IC*PROVIDER SERVICES*TE*8004478255~LE*2120~EB*R*IND*30~REF*18*3F92G08AC99~LS*2120~NM1*P4*2*MEDICARE ABDQMB~LE*2120~SE*44*244752630~GE*1*244752630~IEA*1*244752630~