ISA*00*          *00*          *ZZ*1487113239     *ZZ*1073904009     *251105*1111*^*00501*000000857*0*P*>~
GS*HS*1073904009*1073904009*251105*1111*1073904009*X*005010X279A1~
ST*270*000000857*005010X279A1~
BHT*0022*13*000000857*2511309*1111~
HL*1**20*1~
NM1*PR*2*AETNA MEDICARE ADVANTAGE*****PI*600114~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*JONES*EDNA****MI*1016655252~
DMG*D8*19420512*F~
DTP*291*RD8*20251105-20260203~
EQ*42~
EQ*30~
SE*14*000000857~
GE*1*857~
IEA*1*000000857~