ISA*00*          *00*          *ZZ*EMEDNYMCR      *ZZ*8-DIGIT PLAN ID*240724*1409*^*00501*242060001*0*T*:~GS*BE*EMEDNYMCR*ETIN*20240724*140914*242060001*X*005010X220A1~ST*834*242060000*005010X220A1~BGN*00*2420600000000006XF2420600000016000*20240724*140914****2~QTY*TO*1~N1*P5*MEDICAID*FI*141797357~N1*IN**94*8-DIGIT PLAN ID~INS*Y*18*024**A***TE~REF*0F*XX49994X~REF*17*XX49994X~REF*3H*99B999999X~REF*ABB*XX49994X~DTP*356*D8*20240701~DTP*357*D8*20240701~NM1*IL*1*SUBSCRIBER D LAST NAME*SUBSCRIBER D FIRST NAME*I***34*499999994~PER*IP**TE*9999999999~N3*123 ANY STREET~N4*ANYTOWN*NY*12205~DMG*D8*20040404*M**:RET:R5~NM1*QD*1*CASE NAME~HD*024**HLT**IND~DTP*348*D8*20240701~DTP*349*D8*20240701~REF*X9*PLAN ASSIGNED POLICY NUM~LX*1~NM1*Y2*2******SV*8-DIGIT PLAN ID*72~LS*2700~LX*1~N1*75*FAM IND~REF*17*F~LX*2~N1*75*COE CODE~REF*17*30~DTP*007*D8*20240701~LX*3~N1*75*MONEY CODE~REF*17*00~DTP*007*D8*20240701~LX*4~N1*75*FISCAL COUNTY~REF*17*66~DTP*007*D8*20240701~LX*5~N1*75*AID CAT CODE~REF*17*31~DTP*007*D8*20240701~LX*6~N1*75*BEN PKG CODE~REF*17*66~DTP*007*D8*20240701~LX*7~N1*75*ORIGIN CODE~REF*17*D~DTP*007*D8*20240701~LX*8~N1*75*COPAY EXEMPT IND~REF*ZZ*Y~LX*9~N1*75*BUYIN~REF*17*P~DTP*007*RD8*20230101-20230531~LX*10~N1*75*BUYIN~REF*17*P~DTP*007*RD8*20240101-20240131~LX*11~N1*75*ADDL MAINT REASON~REF*17*CANCEL~LE*2700~SE*68*242060000~GE*1*242060001~IEA*1*242060001~