ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *251105*1511*^*00501*000000816*0*P*>~
GS*HS*52095*52095*251105*1511*1073904009*X*005010X279A1~
ST*270*000000816*005010X279A1~
BHT*0022*13*000000816*2511309*1511~
HL*1**20*1~
NM1*PR*2*KAISER MEDICAID*****PI*52095~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*LOVE*KEVIN****MI*53269561~
DMG*D8*19640728*M~
DTP*291*RD8*20251105-20260203~
EQ*42~
EQ*30~
SE*14*000000816~
GE*1*816~
IEA*1*000000816~