ISA*00*          *00*          *ZZ*               *ZZ*               *250812*1408*^*00501*000000039*0*P*>~
GS*HS***250812*1408*1073904009*X*005010X279A1~
ST*270*000000039*005010X279A1~
BHT*0022*13*000000039*2508224*1408~
HL*1**20*1~
NM1*PR*2*BCBS CAREFIRST*****PI*600110~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*ABLAZA*EDGARDO****MI*YMI185M92526~
DMG*D8*19690111*M~
DTP*291*RD8*20250812-20251110~
EQ*42~
EQ*30~
SE*14*000000039~
GE*1*39~
IEA*1*000000039~