ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *250905*0909*^*00501*000031796*0*P*>~
GS*HS*52095*52095*250905*0909*1487113239*X*005010X279A1~
ST*270*000031796*005010X279A1~
BHT*0022*13*000031796*2509248*0909~
HL*1**20*1~
NM1*PR*2*KAISER MEDICAID*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*ROGERS*ANTOINE****MI*9999999~
DMG*D8*19820427*M~
DTP*291*RD8*20250905-20251204~
EQ*42~
EQ*30~
SE*14*000031796~
GE*1*31796~
IEA*1*000031796~