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GS*HC*1457998957*SKAZ0*20260728*1507*0738*X*005010X222A1~
ST*837*150738*005010X222A1~
BHT*0019*00*000004*20260728*1507*CH~
NM1*41*2*DEVOTION HOME HEALTH CARE, LLC*****46*843850735~
PER*IC*MARIA HUTTO*TE*4804154423~
NM1*40*2*AHCCCS*****46*SKAZ0~
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*******MC~
NM1*IL*1*KALECTACA*ANDREA****MI*A24450555~
N3*5132 N 15TH ST APT 158~
N4*PHOENIX*AZ*85014~
DMG*D8*19621224*F~
NM1*PR*2*AHCCCS*****PI*SKAZ0~
N3*P O BOX 1700~
N4*PHOENIX*AZ*850029999~
CLM*1184-260728150738*1031.6***12>B>1*Y*A*Y*Y~
REF*G1*001560923~
HI*ABK>L97913HI*ABK>I69351*ABF>L88*ABF>I69121*ABF>E1151*ABF>I69318*ABF>I129*ABF>M62421*ABF>E1122*ABF>R2681*ABF>N1830*ABF>R2243*ABF>E785*ABF>Z9989*ABF>Z7901*ABF>Z86711*ABF>Z86718~
NM1*DN*1*HAYDEN*HELEN****XX*1700161791~
NM1*77*2*HOME*****XX*~
N3*11201 N TATUM BLVD, SUITE 300~
N4*PHOENIX*AZ*850286039~
LX*1~
SV1*HC>G0299*118.36*UN*4***1>2>3>4~
DTP*472*D8*20260605~
LX*2~
SV1*HC>G0299*118.36*UN*4***1>2>3>4~
DTP*472*D8*20260608~
LX*3~
SV1*HC>G0299*117.76*UN*3***1>2>3>4~
DTP*472*D8*20260610~
LX*4~
SV1*HC>G0299*117.76*UN*2***1>2>3>4~
DTP*472*D8*20260612~
LX*5~
SV1*HC>G0299*117.76*UN*3***1>2>3>4~
DTP*472*D8*20260615~
LX*6~
SV1*HC>G0299*117.76*UN*4***1>2>3>4~
DTP*472*D8*20260619~
LX*7~
SV1*HC>G0299*88.32*UN*2***1>2>3>4~
DTP*472*D8*20260622~
LX*8~
SV1*HC>G0299*117.76*UN*4***1>2>3>4~
DTP*472*D8*20260626~
LX*9~
SV1*HC>G0299*117.76*UN*2***1>2>3>4~
DTP*472*D8*20260701~
SE*58*150738~
GE*1*0738~
IEA*1*728150738~