ISA*00*          *00*          *ZZ*10353          *ZZ*10353          *251218*1312*^*00501*000001269*0*P*>~
GS*HS*10353*10353*251218*1312*1073904009*X*005010X279A1~
ST*270*000001269*005010X279A1~
BHT*0022*13*000001269*2512352*1312~
HL*1**20*1~
NM1*PR*2*HUMANA GOLD CHOICE*****PI*6013~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*POTTS*LAUREN****MI*H98092069~
DMG*D8*19560902*M~
DTP*291*RD8*20251218-20260318~
EQ*42~
EQ*30~
SE*14*000001269~
GE*1*1269~
IEA*1*000001269~