HIPAA 5010 271 Generic Response

ISA*00*          *00*          *ZZ*1234567        *ZZ*11111          *170508*1141*>*00501*000000101*1*P*:~
GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X279A1~
ST*271*4321*005010X279A1~
BHT*0022*11*10001234*20060501*1319~
HL*1**20*1~
NM1*PR*2*ABC COMPANY*****PI*842610001~
HL*2*1*21*1~
NM1*1P*2*BONE AND JOINT CLINIC*****SV*2000035~
HL*3*2*22*0~
TRN*2*93175-012547*9877281234~
NM1*IL*1*SMITH*JOHN****MI*123456789~
N3*15197 BROADWAY AVENUE*APT 215~
N4*KANSAS CITY*MO*64108~
DMG*D8*19630519*M~
DTP*346*D8*20060101~
EB*1**30**GOLD 123 PLAN~
EB*L~
EB*1**1>33>35>47>86>88>98>AL>MH>UC~
EB*B**1>33>35>47>86>88>98>AL>MH>UC*HM*GOLD 123 PLAN*27*10*****Y~
EB*B**1>33>35>47>86>88>98>AL>MH>UC*HM*GOLD 123 PLAN*27*30*****N~
LS*2120~
NM1*P3*1*JONES*MARCUS****SV*0202034~
LE*2120~
SE*22*4321~
GE*1*101~
IEA*1*000000101~
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