ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260203*1102*^*00501*000039486*0*P*>~
GS*HS*52095*52095*260203*1102*1487113239*X*005010X279A1~
ST*270*000039486*005010X279A1~
BHT*0022*13*000039486*260234*1102~
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*BOOTH*JOHN****MI*13185381~
DMG*D8*19610503*F~
DTP*291*RD8*20260203-20260504~
EQ*42~
EQ*30~
SE*14*000039486~
GE*1*39486~
IEA*1*000039486~