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GS*HS*SB530*SB530*250808*1708*1457998957*X*005010X279A1~
ST*270*000000065*005010X279A1~
BHT*0022*13*000000065*2508220*1708~
HL*1**20*1~
NM1*PR*2*BLUE CROSS BLUE SHIELD*****PI*SB530~
HL*2*1*21*1~
NM1*1P*2*DEVOTION HOME HEALTH CARE, LLC*****XX*1457998957~
HL*3*2*22*0~
NM1*IL*1*BANKHEAD*PENELOPE****MI*XYL842146546~
DMG*D8*19470626*F~
DTP*291*RD8*20250808-20251106~
EQ*42~
EQ*30~
SE*14*000000065~
GE*1*65~
IEA*1*000000065~