ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260105*1101*^*00501*000038151*0*P*>~
GS*HS*52095*52095*260105*1101*1487113239*X*005010X279A1~
ST*270*000038151*005010X279A1~
BHT*0022*13*000038151*260105*1101~
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*PATEL*RAXABEN****MI*79266232~
DMG*D8*19610412*M~
DTP*291*RD8*20260105-20260405~
EQ*42~
EQ*30~
SE*14*000038151~
GE*1*38151~
IEA*1*000038151~