ISA*00*          *00*          *ZZ*12345          *ZZ*12345          *250923*1209*^*00501*000000605*0*P*>~
GS*HS*12345*12345*250923*1209*1073904009*X*005010X279A1~
ST*270*000000605*005010X279A1~
BHT*0022*13*000000605*2509266*1209~
HL*1**20*1~
NM1*PR*2*UNITED HEALTH CARE MCR ADVANTAGE*****PI*10784~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*VILLALTA*ANA****MI*905867014-00~
DMG*D8*19520315*F~
DTP*291*RD8*20250923-20251222~
EQ*42~
EQ*30~
SE*14*000000605~
GE*1*605~
IEA*1*000000605~

