ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251031*1210*^*00501*000004327*0*P*>~
GS*HS*52095*52095*251031*1210*1487113239*X*005010X279A1~
ST*270*000004327*005010X279A1~
BHT*0022*13*000004327*2510304*1210~
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*SPANN*DOLORES****MI*89292137~
DMG*D8*19350310*F~
DTP*291*RD8*20251031-20260129~
EQ*42~
EQ*30~
SE*14*000004327~
GE*1*4327~
IEA*1*000004327~