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GS*HS*63092*63092*250910*0909*1487113239*X*005010X279A1~
ST*270*000032271*005010X279A1~
BHT*0022*13*000032271*2509253*0909~
HL*1**20*1~
NM1*PR*2*CIGNA HEALTH SPRING  MEDICARE HMO ADVANTAGE*****PI*10158~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*WRIGHT*ROBERT****MI*36313810~
DMG*D8*19500527*M~
DTP*291*RD8*20250910-20251209~
EQ*42~
EQ*30~
SE*14*000032271~
GE*1*32271~
IEA*1*000032271~