ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251103*1111*^*00501*000034824*0*P*>~
GS*HS*52095*52095*251103*1111*1487113239*X*005010X279A1~
ST*270*000034824*005010X279A1~
BHT*0022*13*000034824*2511307*1111~
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*TODD*BRIDGET****MI*52142853~
DMG*D8*19640420*F~
DTP*291*RD8*20251103-20260201~
EQ*42~
EQ*30~
SE*14*000034824~
GE*1*34824~
IEA*1*000034824~