ISA*00*          *00*          *ZZ*00             *ZZ*               *260526*1124*U*00501*526112436*0*P*>~
GS*HC*1457998957*3432*20260526*1124*2436*X*005010X222A1~
ST*837*112436*005010X222A1~
BHT*0019*00*000004*20260526*1124*CH~
NM1*41*2*DEVOTION HOME HEALTH CARE, LLC*****46*843850735~
PER*IC*MARIA HUTTO*TE*4804154423~
NM1*40*2*UHC AHCCCS/ALTCS*****46*03432~
HL*1**20*1~
NM1*85*2*DEVOTION HOME HEALTH CARE, LLC*****XX*1457998957~
N3*11201 N TATUM BLVD, SUITE 300~
N4*PHOENIX*AZ*850286039~
REF*EI*843850735~
PER*IC*MARIA HUTTO*TE*4804154423~
HL*2*1*22*0~
SBR*P*18**UNKNOWN*****MC~
NM1*IL*1*ZACEK*JONATHAN****MI*A42300224~
N3*4006 W HATCHER RD~
N4*PHOENIX*AZ*85051~
DMG*D8*19730528*M~
NM1*PR*2*UHC AHCCCS/ALTCS*****PI*03432~
N3*PO BOX 5290~
N4*KINGSTON*NY*124029999~
CLM*1184-260526112436*1850***12>B>1*Y*A*Y*Y~
REF*G1*A313333280~
HI*ABK>E11621*ABF>L97523*ABF>L97314*ABF>E11610*ABF>T8469XA*ABF>E1142*ABF>M5416*ABF>F17210*ABF>I890*ABF>E663*ABF>Z6836*ABF>Z452*ABF>Z792~
NM1*DN*1*MALING*SCOTT****XX*1780643395~
NM1*77*2*HOME*****XX*~
N3*11201 N TATUM BLVD, SUITE 300~
N4*PHOENIX*AZ*850286039~
LX*1~
SV1*HC>S9123*130.00*UN*1***1>2>3>4~
DTP*472*D8*20260327~
LX*2~
SV1*HC>G0299*200.00*UN*1***1>2>3>4~
DTP*472*D8*20260330~
LX*3~
SV1*HC>S9123*130.00*UN*1***1>2>3>4~
DTP*472*D8*20260401~
LX*4~
SV1*HC>S9123*130.00*UN*1***1>2>3>4~
DTP*472*D8*20260403~
LX*5~
SV1*HC>G0299*200.00*UN*1***1>2>3>4~
DTP*472*D8*20260406~
LX*6~
SV1*HC>G0299*200.00*UN*1***1>2>3>4~
DTP*472*D8*20260408~
LX*7~
SV1*HC>G0299*200.00*UN*1***1>2>3>4~
DTP*472*D8*20260410~
LX*8~
SV1*HC>S9123*130.00*UN*1***1>2>3>4~
DTP*472*D8*20260413~
LX*9~
SV1*HC>G0299*200.00*UN*1***1>2>3>4~
DTP*472*D8*20260415~
LX*10~
SV1*HC>G0299*200.00*UN*1***1>2>3>4~
DTP*472*D8*20260417~
LX*11~
SV1*HC>S9123*130.00*UN*1***1>2>3>4~
DTP*472*D8*20260420~
SE*64*112436~
GE*1*2436~
IEA*1*526112436~