ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251106*1011*^*00501*000035121*0*P*>~
GS*HS*52095*52095*251106*1011*1487113239*X*005010X279A1~
ST*270*000035121*005010X279A1~
BHT*0022*13*000035121*2511310*1011~
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*AHDI DEZNAB*SHANA****MI*71250950~
DMG*D8*19880415*M~
DTP*291*RD8*20251106-20260204~
EQ*42~
EQ*30~
SE*14*000035121~
GE*1*35121~
IEA*1*000035121~