ISA*00*          *00*          *ZZ*xxxxx          *ZZ*15004          *251013*1010*^*00501*000000749*0*P*>~
GS*HS*15004*15004*251013*1010*1073904009*X*005010X279A1~
ST*270*000000749*005010X279A1~
BHT*0022*13*000000749*2510286*1010~
HL*1**20*1~
NM1*PR*2*MEDICARE PPS*****PI*10000~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*FAX*TEST****MI*5A97T15GD69~
DMG*D8*19601013*M~
DTP*291*RD8*20251013-20260111~
EQ*42~
EQ*30~
SE*14*000000749~
GE*1*749~
IEA*1*000000749~

