ISA*00*          *00*          *ZZ*SUBMITTERID    *ZZ*RECEIVERID     *240101*1200*^*00501*000000001*0*P*:~
GS*HC*SUBMITTERID*RECEIVERID*20240101*1200*1*X*005010X279A1~
ST*270*0001*005010X279A1~
BHT*0022*13*REF123*20240101*1200~
HL*1**20*1~
NM1*PR*2*PAYER NAME*****PI*SKCO0~
HL*2*1*21*1~
NM1*1P*2*PROVIDER NAME*****XX*1234567890~
HL*3*2*22*0~
TRN*2*TRACE001~
NM1*IL*1*DOE*JOHN*A***MI*MEMBER123~
DMG*D8*19800101*M~
EQ*1^30~
SE*10*0001~
GE*1*1~
IEA*1*000000001~