ISA*00*          *00*          *ZZ*12345          *ZZ*12345          *260423*1004*^*00501*000002153*0*P*>~
GS*HS*12345*12345*260423*1004*1073904009*X*005010X279A1~
ST*270*000002153*005010X279A1~
BHT*0022*13*000002153*2604113*1004~
HL*1**20*1~
NM1*PR*2*UNITED HEALTH CARE MCR ADVANTAGE*****PI*10784~
HL*2*1*21*1~
NM1*1P*2*GRACE HOME HEALTHCARE, LLC*****XX*1073904009~
HL*3*2*22*0~
NM1*IL*1*BUENAVENTURA*CONCEPCION****MI*990030349~
DMG*D8*19351208*F~
DTP*291*RD8*20260423-20260722~
EQ*42~
EQ*30~
SE*14*000002153~
GE*1*2153~
IEA*1*000002153~

