Sha256: 9b45896e1fe7cc51c43d40dc9dfa1931de1aa8a3b65b869acf2ce1d5406fb764
Contents?: true
Size: 915 Bytes
Versions: 5
Compression:
Stored size: 915 Bytes
Contents
ISA*00* *00* *01*0000000000001 *01*0000000000002 *100822*1134*U*00200*000000007*0*T*:~ GS*HC*000000000001*000000000002*20100822*1615*7*X*005010X222A1~ ST*837*3701*005010X222A1~ BHT*0019*00*007227*20050215*075420*CH~ NM1*41*2*POKITDOK, INC*****46*1912301953~ PER*IC*FRONT DESK*TE*8001234567~ NM1*40*2*MEDICARE PART B*****46*12345~ HL*1**20*1~ NM1*85*1*CORBIN*BRIAN****XX*1467857193~ N3*123 MAIN ST~ N4*SOME TOWN*SC*123450123~ REF*EI*987654321~ PER*IC*THE DOCTOR*TE*8001234567~ HL*2*1*22*0~ SBR*P*18*******MB~ NM1*IL*1*DOE*JOHN*J***MI*123456789A~ N3*123 MAIN ST~ N4*A TOWN*SC*12345~ DMG*D8*19500101*M~ NM1*PR*2*MEDICARE PART B*****PI*12345~ CLM*CLAIM1*145.5***11:B:1*Y*A*Y*Y~ DTP*454*D8*20050115~ DTP*453*D8*20050110~ DTP*455*D8*20050113~ CR2********A**CHRONIC PAIN AND DISCOMFORT~ HI*BK:7215~ LX*1~ SV1*HC:98940*145.5*UN*1***1~ DTP*472*D8*20050215~ REF*6R*01~ SE*29*3701~ GE*1*7~ IEA*1*000000007~
Version data entries
5 entries across 5 versions & 1 rubygems