HD*12345**MC*200301*200303*5*this is only a test Medical claims file
12345**13*E01003.00710*1*"T4621*220"*000427561*SUB3975473AX*1*000427561*20*M*19480222*GARDINER*ME*04245*20030308*20030114*****01*M1000B1*5556688794**2***MAINE MEDICAL CENTER**HSP*PORTLAND*ME*04211*12*21*01*717**71783*55421*301*4457**********270****6432*20021207*20021217*10*2545000*2105000*0*0*15000*0*MC
12345**13*E01031.03174*1*M246*004379999*BX0977C24Z*3**19*F*19951001*BANGOR*ME*04222*20030108*******K150622*001457783F**1*JOHN*K*SMITH*MD*PED*BANGOR*ME*04222**11*01***250*0340*************87462****20030102*20030102*1*2500*2000*0*0*0*0*MC
12345**13*E01031.03174*2*M246*004379999*BX0977C24Z*3**19*F*19951001*BANGOR*ME*04222*20030108*******K150622*001457783F**1*JOHN*K*SMITH*MD*PED*BANGOR*ME*04222**11*01***250*0340*************99213****20030102*20030102*1*7900*5550*0*2000*0*0*MC
12345**16*E01012.03712*1*"31220*C97A"*006527586*006527586*1*006527586*20*F*19481106*CAPE ELIZABETH*ME*04005*20030208*******MG225*2458416854**1*MARY**LANE*DO*CHIRO*PORTLAND*ME*04211**11*01**E270*6268**************99221****20030120*20030120*1*7950*4275*0*2000*0*0*MC
12345**16*E01212.04578*1*452468*021475835*021475832*2*024568527*01*F*19520704*MANCHESTER*ME*04245*20030315*******557423*6464465MJ4**1*H*WILLIAM*JONES*MD*RAD*AUGUSTA*ME*04215**11*22***7452**************42326****20030115*20030115*-1*-7250*-3205*0*-2000*0*0*MC
TR*12345**MC*200301*200303*20030415