ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260421*1204*^*00501*000044331*0*P*>~
GS*HS*52095*52095*260421*1204*1487113239*X*005010X279A1~
ST*270*000044331*005010X279A1~
BHT*0022*13*000044331*2604111*1204~
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*MOORE*JASON****MI*43321594~
DMG*D8*19781129*M~
DTP*291*RD8*20260421-20260720~
EQ*42~
EQ*30~
SE*14*000044331~
GE*1*44331~
IEA*1*000044331~