ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *251220*1612*^*00501*000037659*0*P*>~
GS*HS*52095*52095*251220*1612*1487113239*X*005010X279A1~
ST*270*000037659*005010X279A1~
BHT*0022*13*000037659*2512354*1612~
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*SLATER*MELINDA****MI*13210654~
DMG*D8*19640728*F~
DTP*291*RD8*20251220-20260320~
EQ*42~
EQ*30~
SE*14*000037659~
GE*1*37659~
IEA*1*000037659~