ISA*00*          *00*          *ZZ*               *ZZ*               *251221*1612*^*00501*000001294*0*P*>~
GS*HS***251221*1612*1073904009*X*005010X279A1~
ST*270*000001294*005010X279A1~
BHT*0022*13*000001294*2512355*1612~
HL*1**20*1~
NM1*PR*2*BCBS CAREFIRST*****PI*600110~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*ADLER*IVAN****MI*XIB902808926~
DMG*D8*19641029*M~
DTP*291*RD8*20251221-20260321~
EQ*42~
EQ*30~
SE*14*000001294~
GE*1*1294~
IEA*1*000001294~