ISA*00*          *00*          *ZZ*1059619        *ZZ*263086998      *250731*1607*^*00501*000000083*0*P*>~
GS*HS*263086998*263086998*250731*1607*1356449631*X*005010X279A1~
ST*270*000000083*005010X279A1~
BHT*0022*13*000000083*2507212*1607~
HL*1**20*1~
NM1*PR*2*TRIWEST UNBUNDLED*****PI*TWVAC~
HL*2*1*21*1~
NM1*1P*2*DELTA HEALTH HOME HEALTH*****XX*1356449631~
HL*3*2*22*0~
NM1*IL*1*BERTRAND*NICHOLAS****MI*1353641006~
DMG*D8*19441222*M~
DTP*291*RD8*20250731-20251029~
EQ*42~
EQ*30~
SE*14*000000083~
GE*1*83~
IEA*1*000000083~