ISA*00*          *00*          *ZZ*xxxxx          *ZZ*52095          *251117*1411*^*00501*000001024*0*P*>~
GS*HS*52095*52095*251117*1411*1073904009*X*005010X279A1~
ST*270*000001024*005010X279A1~
BHT*0022*13*000001024*2511321*1411~
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*FISK*JEFFREY****MI*01094329~
DMG*D8*19380116*M~
DTP*291*RD8*20251117-20260215~
EQ*42~
EQ*30~
SE*14*000001024~
GE*1*1024~
IEA*1*000001024~