ISA*00*          *00*          *ZZ*COMEDICAID     *ZZ*DZINESCO       *240620*1200*^*00501*000000456*0*P*:~
GS*HN*COMEDICAID*DZINESCO*20240620*1200*2*X*005010X214~
ST*277*0001*005010X214~
BHT*0085*08*REFNUM002*20240620*1200*TH~
HL*1**20*1~
NM1*PR*2*COLORADO MEDICAL ASSIST*****PI*COMEDICAID~
HL*2*1*21*1~
HL*3*2*19*1~
HL*4*3*PT~
REF*1K*CLAIM004~
REF*EJ*721587149~
STC*A3:19:PR*20240620*WQ*300.00~
SE*10*0001~
GE*1*1~
IEA*1*000000456~