ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251006*1510*^*00501*000028152*0*P*>~
GS*HS*52095*52095*251006*1510*1487113239*X*005010X279A1~
ST*270*000028152*005010X279A1~
BHT*0022*13*000028152*2510279*1510~
HL*1**20*1~
NM1*PR*2*KAISER PERMANENTE MEDICARE ADVANTAGE 1*****PI*10403~
HL*2*1*21*1~
NM1*1P*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
HL*3*2*22*0~
NM1*IL*1*LOVE*JACK****MI*42215273~
DMG*D8*19580908*M~
DTP*291*RD8*20251006-20260104~
EQ*42~
EQ*30~
SE*14*000028152~
GE*1*28152~
IEA*1*000028152~