ISA*00*          *00*          *12*ABCCOM         *01*999999999      *120117*1719*U*00400*000006768*0*P*>
GS*HS*4405197800*999999999*20120117*1719*1421*X*004010VICS
ST*270*1234
BHT*0022*13*1*20010820*1330
HL*1**20*1
NM1*PR*2*PayerName*****PI*123456789
HL*2*1*21*1
NM1*1P*2*ProviderName*****SV*987654321
HL*3*2*22*0
NM1*IL*1*DOE*JANE****MI*345678901
EQ*30**FAM
SE*10*1234
GE*1*1421
IEA*1*000006768