ISA*00*          *00*          *ZZ*824026167      *ZZ*ABILITY837     *260729*0853*^*00501*000000171*0*P*>~
GS*HS*ABILITY837*ABILITY837*260729*0853*1184225021*X*005010X279A1~
ST*270*000000171*005010X279A1~
BHT*0022*13*000000171*2607210*0853~
HL*1**20*1~
NM1*PR*2*BCBS TANGO MA*****PI*26748~
HL*2*1*21*1~
NM1*1P*2*EVERGREEN HOME HEALTH*****XX*1184225021~
HL*3*2*22*0~
NM1*IL*1*PERRY*PATRICIA****MI*X3LM67042753~
DMG*D8*19400524*F~
DTP*291*RD8*20260729-20261027~
EQ*42~
EQ*30~
SE*14*000000171~
GE*1*171~
IEA*1*000000171~