ISA*00* *00* *ZZ*SUBMITTER1 *ZZ*RECEIVER01 *260830*1200*^*00501*000000001*0*P*:~GS*HC*SENDER*RECEIVER*20260830*1200*1*X*005010X222A1~ST*837*0001*005010X222A1~BHT*0019*00*CLAIM001*20260830*1200*CH~NM1*41*2*DR CLINIC*****46*1234567890~NM1*40*2*RECEIVER*****46*9876543210~HL*1**20*1~NM1*85*2*DR CLINIC*****XX*1234567893~HL*2*1*22*0~NM1*IL*1*SMITH*JANE****MI*W123456780~CLM*CLM001*150.00***11::1*Y*A*Y*Y~HI*BK:M545~LX*1~SV1*HC:99213*150.00*UN*1***1~SE*13*0001~GE*1*1~IEA*1*000000001~