ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251128*1011*^*00501*000004124*0*P*>~
GS*HS*52095*52095*251128*1011*1487113239*X*005010X279A1~
ST*270*000004124*005010X279A1~
BHT*0022*13*000004124*2511332*1011~
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*ROPKA*LINDA****MI*54311406~
DMG*D8*19490123*F~
DTP*291*RD8*20251128-20260226~
EQ*42~
EQ*30~
SE*14*000004124~
GE*1*4124~
IEA*1*000004124~