stupidedi 1.3.23 → 1.4.0

data/spec/fixtures/X218-RA820/1-bad.txt

@@ -1,31 +0,0 @@
-Scenario One Description 
-
-This example shows a premium payer submitting an 820 transaction set to pay a summary bill for group major medical and disability bill (Invoiced).
-
-Errors Found in File 820 5010X218-1
-* W10009:Padding, spaces or control characters detected after segment terminator.
-* H11204:Code Value 'XX' not used for element 'GS01'
-* H25446:Code '24' expected but not received for a HIPAA Compliant Implementation.
-* H25450:SAC Segment was expected but not found because IT1 segment is present.
-* H46314:Value must be unique for every occurance of the segment within a transaction.
-* H46314:Value must be unique for every occurance of the segment within a transaction.
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X218~
-ST*820*0001*005010X218~
-BPR*C*19000*C*ACH*CTX*01*999999992*DA*12345678*1030449999**01*199999999*DA*98765*20070516~
-TRN*1*12345*1030449999~
-REF*14*12345~
-N1*PE*DEF HEALTH CARE INC.*FI*012222222~
-N1*PR*ABC PLASTICS*FI*123456789~
-ENT*1*2L*FI*123456789~
-RMR*IK*970501001*PI*16500~
-IT1*1~
-SLN*1**O*5*IE~
-SLN*2**O*75*10~
-RMR*IK*970501002*PI*2500~
-IT1*1~
-SLN*1**O*25*IE~
-SE*15*0001~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X218-RA820/1-good.txt

@@ -1,25 +0,0 @@
-Scenario One Description 
-
-This example shows a premium payer submitting an 820 transaction set to pay a summary bill for group major medical and disability bill (Invoiced).
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*RA*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X218~
-ST*820*0001*005010X218~
-BPR*C*19000*C*ACH*CTX*01*999999992*DA*12345678*1030449999**01*199999999*DA*98765*20070516~
-TRN*1*12345*1030449999~
-REF*14*12345~
-N1*PE*DEF HEALTH CARE INC.*FI*012222222~
-N1*PR*ABC PLASTICS*FI*123456789~
-ENT*1*2L*24*123456789~
-RMR*IK*970501001*PI*16500~
-IT1*1~
-SAC*C*D940***120~
-SLN*1**O*5*IE~
-SLN*2**O*75*10~
-RMR*IK*970501002*PI*2500~
-IT1*2~
-SAC*C*D940***150~
-SLN*3**O*25*IE~
-SE*17*0001~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X218-RA820/2-bad.txt

@@ -1,37 +0,0 @@
-Scenario Two Description 
-
-This example demonstrates a List Bill payment. This example shows a premium payer submitting an 820 transaction set to pay a group employee life insurance premium bill (Invoice).
-
-Errors Found in File 820 5010X218-2
-* W10009:Padding, spaces or control characters detected after segment terminator.
-* H11204:Code Value 'XX' not used for element 'GS01'
-* H23028:At least one Individual Premium Remittance Detail (2300B RMR) must contain either Invoice Received 'IK' or Invoice Not Received 'AZ' in the Reference Identification Qualifier (RMR01).
-* H23028:At least one Individual Premium Remittance Detail (2300B RMR) must contain either Invoice Received 'IK' or Invoice Not Received 'AZ' in the Reference Identification Qualifier (RMR01).
-* H23028:At least one Individual Premium Remittance Detail (2300B RMR) must contain either Invoice Received 'IK' or Invoice Not Received 'AZ' in the Reference Identification Qualifier (RMR01).
-* H23028:At least one Individual Premium Remittance Detail (2300B RMR) must contain either Invoice Received 'IK' or Invoice Not Received 'AZ' in the Reference Identification Qualifier (RMR01).
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X218~
-ST*820*0001*005010X218~
-BPR*C*255*C*ACH*CTX*01*999999992*DA*12345678*1345678901**01*199999999*DA*98765*20071103~
-TRN*1*78905*1345678901~
-REF*14*0011001~
-N1*PE*BATA INSURANCE CO.*FI*012222222~
-N1*PR*ALFA MEDAL CO*FI*123456789~
-ENT*1*2J*34*030440099~
-NM1*EY*1*DOE*JOHN****EI*777222~
-RMR*IG*555666**30~
-RMR*IG*555667**35~
-ENT*2*2J*34*029500563~
-NM1*EY*1*FIRSTONE*EMILY****EI*777333~
-RMR*IG*555777**45~
-ENT*3*2J*34*029480664~
-NM1*EY*1*MIDDLEONE*JULIE****EI*777444~
-RMR*IG*544477**50~
-ENT*4*2J*34*030498099~
-NM1*EY*1*NEWONE*KELLY****EI*777111~
-RMR*IG*551166**45~
-RMR*IG*558766**50~
-SE*21*0001~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X218-RA820/2-good.txt

@@ -1,29 +0,0 @@
-Scenario Two Description 
-
-This example demonstrates a List Bill payment. This example shows a premium payer submitting an 820 transaction set to pay a group employee life insurance premium bill (Invoice).
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*RA*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X218~
-ST*820*0001*005010X218~
-BPR*C*255*C*ACH*CTX*01*999999992*DA*12345678*1345678901**01*199999999*DA*98765*20071103~
-TRN*1*78905*1345678901~
-REF*14*0011001~
-N1*PE*BATA INSURANCE CO.*FI*012222222~
-N1*PR*ALFA MEDAL CO*FI*123456789~
-ENT*1*2J*34*030440099~
-NM1*EY*1*DOE*JOHN****EI*777222~
-RMR*IK*555666**30~
-RMR*IG*555667**35~
-ENT*2*2J*34*029500563~
-NM1*EY*1*FIRSTONE*EMILY****EI*777333~
-RMR*IK*555777**45~
-ENT*3*2J*34*029480664~
-NM1*EY*1*MIDDLEONE*JULIE****EI*777444~
-RMR*IK*544477**50~
-ENT*4*2J*34*030498099~
-NM1*EY*1*NEWONE*KELLY****EI*777111~
-RMR*IK*551166**45~
-RMR*IG*558766**50~
-SE*21*0001~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X218-RA820/3-bad.txt

@@ -1,29 +0,0 @@
-Scenario Three Description 
-
-This example illustrates a premium payer using a third party payroll processor. The 820 transaction is set to have the remittance information and the dollars travel on separately.
-
-Errors Found in File 820 5010X218-3
-* W10009:Padding, spaces or control characters detected after segment terminator.
-* H11204:Code Value 'XX' not used for element 'GS01'
-* H20600:The value '1231555555' does not match the format for a "Federal Tax Identification Number"
-* H25446:Code '24' expected but not received for a HIPAA Compliant Implementation.
-* H25450:SAC Segment was expected but not found because IT1 segment is present.
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X218~
-ST*820*0002*005010X218~
-BPR*U*20000*C*ACH*CCP*01*934257813*DA*1234587*1231555555**01*025677833*DA*99887766*20070620~
-TRN*3*12345*1231555555~
-REF*14*673001~
-REF*2F*0004369123~
-N1*PE*DEF HEALTHCARE CO*FI*998216353~
-N1*PR*ABC PLASTICS*FI*1231555555~
-ENT*1*2L*FI*000057811~
-RMR*IK*0004369123*PI*20000~
-IT1*1~
-SLN*1**O*100*IE~
-SLN*2**O*75*PR~
-SLN*3**O*125*10~
-SE*14*0002~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X218-RA820/3-good.txt

@@ -1,23 +0,0 @@
-Scenario Three Description 
-
-This example illustrates a premium payer using a third party payroll processor. The 820 transaction is set to have the remittance information and the dollars travel on separately.
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*RA*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X218~
-ST*820*0002*005010X218~
-BPR*U*20000*C*ACH*CCP*01*934257813*DA*1234587*1231555555**01*025677833*DA*99887766*20070620~
-TRN*3*12345*1231555555~
-REF*14*673001~
-REF*2F*0004369123~
-N1*PE*DEF HEALTHCARE CO*FI*998216353~
-N1*PR*ABC PLASTICS*24*123155555~
-ENT*1*2L*24*000057811~
-RMR*IK*0004369123*PI*20000~
-IT1*1~
-SAC*C*D940***200~
-SLN*1**O*100*IE~
-SLN*2**O*75*PR~
-SLN*3**O*125*10~
-SE*15*0002~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X218-RA820/4-bad.txt

@@ -1,36 +0,0 @@
-Scenario Four Description 
-
-This example illustrates a premium payer, using a third party payroll processor, sending an 820 transaction set where the remittance information and the dollars travel on separate paths. The payment detail will list each individual employee, the policy numbers, payment amounts and adjustment amounts.
-
-Errors Found in File 820 5010X218-4
-* W10009:Padding, spaces or control characters detected after segment terminator.
-* H11204:Code Value 'XX' not used for element 'GS01'
-* H23028:At least one Individual Premium Remittance Detail (2300B RMR) must contain either Invoice Received 'IK' or Invoice Not Received 'AZ' in the Reference Identification Qualifier (RMR01).
-* H23028:At least one Individual Premium Remittance Detail (2300B RMR) must contain either Invoice Received 'IK' or Invoice Not Received 'AZ' in the Reference Identification Qualifier (RMR01).
-* H23025:For HIPAA Health Premium Payments the code 'IK' is REQUIRED when an invoice has been received from a health plan.
-* H23028:At least one Individual Premium Remittance Detail (2300B RMR) must contain either Invoice Received 'IK' or Invoice Not Received 'AZ' in the Reference Identification Qualifier (RMR01).
-* H23025:For HIPAA Health Premium Payments the code 'IK' is REQUIRED when an invoice has been received from a health plan.
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X218~
-ST*820*0002*005010X218~
-BPR*U*20000*C*ACH*CCP*01*934257813*DA*1234587*1231555555**01*025677833*DA*99887766*20070620~
-TRN*3*12345*1231555555~
-REF*14*673001~
-REF*2F*0004369123~
-N1*PE*DEF HEALTHCARE CO*FI*998216353~
-N1*PR*ABC PLASTICS*FI*000057811~
-ENT*1*2J*34*190206123~
-NM1*EY*1*SMITH*JOHN****EI*123456~
-RMR*CT*190206123**7000~
-ENT*2*2J*34*163910163~
-NM1*EY*1*JONES*MARY****EI*793016~
-RMR*CT*163910163**10000*11000~
-ADX*-1000*52~
-ENT*3*2J*34*179203456~
-NM1*EY*1*JOHNSON*JOE****EI*934213~
-RMR*CT*179203456**3000*3100~
-ADX*-100*52~
-SE*19*0002~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X218-RA820/4-good.txt

@@ -1,27 +0,0 @@
-Scenario Four Description 
-
-This example illustrates a premium payer, using a third party payroll processor, sending an 820 transaction set where the remittance information and the dollars travel on separate paths. The payment detail will list each individual employee, the policy numbers, payment amounts and adjustment amounts.
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*RA*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X218~
-ST*820*0002*005010X218~
-BPR*U*20000*C*ACH*CCP*01*934257813*DA*1234587*1231555555**01*025677833*DA*99887766*20070620~
-TRN*3*12345*1231555555~
-REF*14*673001~
-REF*2F*0004369123~
-N1*PE*DEF HEALTHCARE CO*FI*998216353~
-N1*PR*ABC PLASTICS*FI*000057811~
-ENT*1*2J*34*190206123~
-NM1*EY*1*SMITH*JOHN****EI*123456~
-RMR*IK*190206123**7000~
-ENT*2*2J*34*163910163~
-NM1*EY*1*JONES*MARY****EI*793016~
-RMR*IK*163910163**10000*11000~
-ADX*-1000*52~
-ENT*3*2J*34*179203456~
-NM1*EY*1*JOHNSON*JOE****EI*934213~
-RMR*IK*179203456**3000*3100~
-ADX*-100*52~
-SE*19*0002~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X220-BE834/1-bad.txt

@@ -1,35 +0,0 @@
-Business Case Scenario 1 - Enroll an Employee in Multiple Health Care Insurance Products 
-
-The subscriber is enrolling in three health care products -- health, dental, and vision. The subscriber also has Coordination of Benefits (COB) with another insurance company.
-
-Errors Found in File 834 5010X220-1
-* W10009:Padding, spaces or control characters detected after segment terminator.
-* H11204:Code Value 'XX' not used for element 'GS01'
-* H25518:Code '24' is requried for a HIPAA compliant transaction.
-* H10913:Transaction Set Control Number '12345' does not match ST02's '0001'.
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X220~
-ST*834*0001*005010X220~
-BGN*00*12456*19980520*1200****2~
-N1*P5**FI*999888777~
-N1*IN**FI*654456654~
-INS*Y*18*021*20*A***FT~
-REF*0F*123456789~
-REF*1L*123456001~
-DTP*356*D8*19960523~
-NM1*IL*1*DOE*JOHN*P***34*123456789~
-PER*IP**HP*7172343334*WP*7172341240~
-N3*100 MARKET ST*APT 3G~
-N4*CAMP HILL*PA*17011**CY*CUMBERLAND~
-DMG*D8*19400816*M~
-HD*021**HLT~
-DTP*348*D8*19960601~
-COB*P*890111*5~
-HD*021**DEN~
-DTP*348*D8*19960601~
-HD*021**VIS~
-DTP*348*D8*19960601~
-SE*21*12345~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X220-BE834/1-good.txt

@@ -1,29 +0,0 @@
-Business Case Scenario 1 - Enroll an Employee in Multiple Health Care Insurance Products 
-
-The subscriber is enrolling in three health care products -- health, dental, and vision. The subscriber also has Coordination of Benefits (COB) with another insurance company.
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*BE*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X220~
-ST*834*0001*005010X220~
-BGN*00*12456*19980520*1200****2~
-N1*P5**24*999888777~
-N1*IN**FI*654456654~
-INS*Y*18*021*20*A***FT~
-REF*0F*123456789~
-REF*1L*123456001~
-DTP*356*D8*19960523~
-NM1*IL*1*DOE*JOHN*P***34*123456789~
-PER*IP**HP*7172343334*WP*7172341240~
-N3*100 MARKET ST*APT 3G~
-N4*CAMP HILL*PA*17011**CY*CUMBERLAND~
-DMG*D8*19400816*M~
-HD*021**HLT~
-DTP*348*D8*19960601~
-COB*P*890111*5~
-HD*021**DEN~
-DTP*348*D8*19960601~
-HD*021**VIS~
-DTP*348*D8*19960601~
-SE*21*0001~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X220-BE834/10-bad.txt

@@ -1,26 +0,0 @@
-Business Case Scenario 10 - Reinstate Member Eligibility (INS) 
-
-A member is reinstated as eligible without reinstatement of coverage in a particular benefit.
-
-Errors Found in File 834 5010X220-10
-* W10009:Padding, spaces or control characters detected after segment terminator.
-* H11204:Code Value 'XX' not used for element 'GS01'
-* H25518:Code '24' is requried for a HIPAA compliant transaction.
-* H46408:'Member Demographics' was not found, but was expected because the Maintenance Type Code is 'Change in Identifiying Elements' (INS03=025).
-* H46206:The Individual Patient Identifier has not been mandated for use.
-* H10913:Transaction Set Control Number '12345' does not match ST02's '0001'.
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X220~
-ST*834*0001*005010X220~
-BGN*00*12456*20020601*1200****2~
-REF*38*ABCD012354~
-N1*P5**FI*999888777~
-N1*IN**FI*654456654~
-INS*Y*18*025**A***FT~
-REF*0F*202443307~
-REF*1L*123456001~
-NM1*IL*1*SMITH*WILLIAM****ZZ*2024433307~
-SE*10*12345~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X220-BE834/10-good.txt

@@ -1,19 +0,0 @@
-Business Case Scenario 10 - Reinstate Member Eligibility (INS) 
-
-A member is reinstated as eligible without reinstatement of coverage in a particular benefit.
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*BE*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X220~
-ST*834*12345*005010X220~
-BGN*00*12456*20020601*1200****2~
-REF*38*ABCD012354~
-N1*P5**24*999888777~
-N1*IN**FI*654456654~
-INS*Y*18*025**A***FT~
-REF*0F*202443307~
-REF*1L*123456001~
-NM1*IL*1*SMITH*WILLIAM****34*202443330~
-DMG*D8*19590428*M~
-SE*11*12345~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X220-BE834/2-bad.txt

@@ -1,31 +0,0 @@
-Business Case Scenario 2 - Add a Dependent (Full-time Student) to an Existing Enrollment 
-
-The subscriber is enrolling a dependent who is a full-time student.
-
-Errors Found in File 834 5010X220-2
-* W10009:Padding, spaces or control characters detected after segment terminator.
-* H11204:Code Value 'XX' not used for element 'GS01'
-* H25518:Code '24' is requried for a HIPAA compliant transaction.
-* W25233:'Student Status Code' (INS09) may need to be evaluated when Member is a non-spouse and is over 18 years of age. See plan for age details and sutdent status requriements..
-* H20203:Element HD02 is present, though marked 'Not Used'
-* H24391:Missing HIPAA Required 'HD03'.
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X220~
-ST*834*0001*005010X220~
-BGN*00*12456*19980520*1200****2~
-REF*38*ABCD012354~
-N1*P5**FI*999888777~
-N1*IN**FI*654456654~
-INS*N*19*021*28*A****F~
-REF*0F*123456789~
-REF*1L*123456001~
-DTP*351*D8*19980515~
-NM1*IL*1*DOE*JAMES*E***34*103229876~
-DMG*D8*19770816*M~
-NM1*M8*2*PENN STATE UNIVERSITY~
-HD*021*HLT~
-DTP*348*D8*19960601~
-SE*15*0001~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X220-BE834/2-good.txt

@@ -1,23 +0,0 @@
-Business Case Scenario 2 - Add a Dependent (Full-time Student) to an Existing Enrollment 
-
-The subscriber is enrolling a dependent who is a full-time student.
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*BE*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X220~
-ST*834*0001*005010X220~
-BGN*00*12456*19980520*1200****2~
-REF*38*ABCD012354~
-N1*P5**24*999888777~
-N1*IN**FI*654456654~
-INS*N*19*021*28*A****F~
-REF*0F*123456789~
-REF*1L*123456001~
-DTP*351*D8*19980515~
-NM1*IL*1*DOE*JAMES*E***34*103229876~
-DMG*D8*19770816*M~
-NM1*M8*2*PENN STATE UNIVERSITY~
-HD*021**HLT~
-DTP*348*D8*19960601~
-SE*15*0001~
-GE*1*1~
-IEA*1*000000905~

data/spec/fixtures/X220-BE834/3-bad.txt

@@ -1,36 +0,0 @@
-Business Case Scenario 3 - Enroll an Employee in a Managed Care Product 
-
-The subscriber is enrolling in an HMO product.
-
-Errors Found in File 834 5010X220-3
-* W10009:Padding, spaces or control characters detected after segment terminator.
-* H11204:Code Value 'XX' not used for element 'GS01'
-* H25518:Code '24' is requried for a HIPAA compliant transaction.
-* H10014:Leading zeros detected in LX01. The X12 syntax requires the suppression of leading zeros for numeric elements
-* H20059:'Provider Last or Organization Name' was not expected because the Provider Primary ID (NM109) is present.
-* H20059:'Provider First Name' was not expected because the Provider Primary ID (NM109) is present.
-* H20059:'Provider Name Prefix' was not expected because the Provider Primary ID (NM109) is present.
-* H21084:Invalid qualifier 'SV' found in '2310 NM108'. Only 'XX' is valid because the National Provider Identifier (NPI) is now mandated for use.
-
-ISA*00*..........*01*SECRET....*ZZ*SUBMITTERS.ID..*ZZ*RECEIVERS.ID...*030101*1253*^*00501*000000905*1*T*:~
-GS*XX*SENDER CODE*RECEIVER CODE*19991231*0802*1*X*005010X220~
-ST*834*0001*005010X220~
-BGN*00*12456*19980520*1200****2~
-N1*P5**FI*999888777~
-N1*IN**FI*654456654~
-INS*Y*18*021*20*A***FT~
-REF*0F*202443307~
-REF*1L*123456001~
-DTP*356*D8*19960112~
-NM1*IL*1*SMITH*WILLIAM****34*202443307~
-PER*IP**HP*7172343334*WP*7172341240~
-N3*1715 SOUTHWIND AVENUE~
-N4*ANYTOWN*PA*171110000~
-DMG*D8*19700614*M~
-HD*021**HMO~
-DTP*348*D8*19960601~
-LX*01~
-NM1*P3*1*BROWN*BERNARD**DR**SV*143766*25~
-SE*18*0001~
-GE*1*1~
-IEA*1*000000905~