ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251008*1510*^*00501*000031919*0*P*>~
GS*HS*52095*52095*251008*1510*1487113239*X*005010X279A1~
ST*270*000031919*005010X279A1~
BHT*0022*13*000031919*2510281*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*SIBISKI*KATHERINE****MI*581182935~
DMG*D8*19480807*F~
DTP*291*RD8*20251008-20260106~
EQ*42~
EQ*30~
SE*14*000031919~
GE*1*31919~
IEA*1*000031919~