ISA*00*          *00*          *ZZ*EMEDNYMCR      *ZZ*8-DIGIT PLAN ID*210824*1409*^*00501*212360001*0*T*:~GS*BE*EMEDNYMCR*ETIN*20210824*140914*212360001*X*005010X220A1~ST*834*212360000*005010X220A1~BGN*00*2123600000000005XF2123600000006000*20210824*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*20210801~DTP*357*D8*20210801~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*20210801~DTP*349*D8*20210801~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*20210801~LX*3~N1*75*MONEY CODE~REF*17*00~DTP*007*D8*20210801~LX*4~N1*75*FISCAL COUNTY~REF*17*66~DTP*007*D8*20210801~LX*5~N1*75*AID CAT CODE~REF*17*31~DTP*007*D8*20210801~LX*6~N1*75*BEN PKG CODE~REF*17*66~DTP*007*D8*20210801~LX*7~N1*75*ORIGIN CODE~REF*17*D~DTP*007*D8*20210801~LX*8~N1*75*COPAY EXEMPT IND~REF*ZZ*Y~LX*9~N1*75*ADDL MAINT REASON~REF*17*CANCEL~LE*2700~SE*60*212360000~GE*1*212360001~IEA*1*212360001~