Raw X12 — CIN ZR15262M

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1120*|*00501*384843054*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1120*843054*X*005010X279A1~ST*270*3054*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*ZR15262M~EQ*30~DTP*291*D8*20260914~SE*13*3054~GE*1*843054~IEA*1*384843054~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0720*^*00501*244857830*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*072043*244857830*X*005010X279A1~ST*271*244857830*005010X279A1~BHT*0022*11*202609141120000001*20260914*072043~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*MARCANO*SERGIO****MI*ZR15262M~N3*175      WEST 95TH ST         27C~N4*NEW YORK*NY*10025~DMG*D8*19510926*M~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20251101~EB*U*IND*30**ELIGIBLE PCP~MSG*CF~MSG*S1~MSG*CNTY CD=66 5H9~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*ELDERPLAN INC HOMEFIRST PARTIAL LTC*****PI*ED~N3*55 WATER ST FL 46~N4*NEW YORK*NY*100413211~PER*IC*PROVIDER SERVICES*TE*8777711119~LE*2120~EB*B*IND*30***29*0~EB*1*IND*82~EB*1*IND*88~EB*R*IND*30~REF*6P*H3418~LS*2120~NM1*P4*2*AARP MEDICARE ADVANTAGE MOSAIC CHOI*****PI*H3418~N3*PO BOX 31362~N4*SALT LAKE CITY*UT*84131~PER*IC*PROVIDER SERVICES*TE*1800643484~LE*2120~EB*R*IND*30~REF*18*6T98HY2QY56~LS*2120~NM1*P4*2*MEDICARE ABD~LE*2120~SE*44*244857830~GE*1*244857830~IEA*1*244857830~