ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251027*1310*^*00501*000031491*0*P*>~
GS*HS*52095*52095*251027*1310*1487113239*X*005010X279A1~
ST*270*000031491*005010X279A1~
BHT*0022*13*000031491*2510300*1310~
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*HAWKINS*JOHN****MI*981167819~
DMG*D8*19630621*M~
DTP*291*RD8*20251027-20260125~
EQ*42~
EQ*30~
SE*14*000031491~
GE*1*31491~
IEA*1*000031491~