Raw X12 — CIN UJ19209R

ISA*00*          *00*          *ZZ*00ND           *ZZ*EMEDNYREL      *260914*1120*|*00501*384859068*1*P*:~GS*HS*00ND*EMEDNYREL*20260914*1120*859068*X*005010X279A1~ST*270*9068*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*UJ19209R~EQ*30~DTP*291*D8*20260914~SE*13*9068~GE*1*859068~IEA*1*384859068~

ISA*00*          *00*          *ZZ*EMEDNYREL      *ZZ*00ND           *260914*0720*^*00501*245182030*0*P*|~GS*HB*EMEDNYREL*00ND*20260914*072059*245182030*X*005010X279A1~ST*271*245182030*005010X279A1~BHT*0022*11*202609141120000001*20260914*072059~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*PINELAJURADO*ULBIA****MI*UJ19209R~N3*3724     93RD ST              1FL~N4*JACKSON HEIGHTS*NY*11372~DMG*D8*19630422*F~DTP*472*D8*20260914~DTP*346*D8*20260901~DTP*102*D8*20251101~EB*U*IND*30**ELIGIBLE PCP~MSG*PD~MSG*CNTY CD=66 523~MSG*RECERT MONTH=10~LS*2120~NM1*Y2*2*HEALTH FIRST PHSP INC*****PI*SF~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*88~SE*29*245182030~GE*1*245182030~IEA*1*245182030~