ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251204*1712*^*00501*000034368*0*P*>~
GS*HS*52095*52095*251204*1712*1487113239*X*005010X279A1~
ST*270*000034368*005010X279A1~
BHT*0022*13*000034368*2512338*1712~
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*HYATT*JANICE****MI*49214889~
DMG*D8*19490929*F~
DTP*291*RD8*20251204-20260304~
EQ*42~
EQ*30~
SE*14*000034368~
GE*1*34368~
IEA*1*000034368~