ISA*00*          *00*          *ZZ*PAYERID        *ZZ*PROVIDERID     *240101*1200*^*00501*000000002*0*P*:~
GS*HC*PAYERID*PROVIDERID*20240101*1200*2*X*005010X279A1~
ST*271*0001*005010X279A1~
BHT*0022*11*REF456*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~
EB*1*IND*30**Y*1~
MSG*Patient has active coverage~
EB*88*IND**100*N**~
MSG*Pharmacy copay $20~
SE*13*0001~
GE*1*2~
IEA*1*000000002~