ISA*00*          *00*          *ZZ*52095          *ZZ*52095          *260708*1507*^*00501*000028821*0*P*>~
GS*HS*52095*52095*260708*1507*1487113239*X*005010X279A1~
ST*270*000028821*005010X279A1~
BHT*0022*13*000028821*2607189*1507~
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*BARNES*IDA****MI*51197387~
DMG*D8*19611028*F~
DTP*291*RD8*20260708-20261006~
EQ*42~
EQ*30~
SE*14*000028821~
GE*1*28821~
IEA*1*000028821~