ISA*00*          *00*          *ZZ*00             *ZZ*               *260722*1830*U*00501*722183021*0*P*>~
GS*HC*52095*52095*20260722*1830*3021*X*005010X223A2~
ST*837*183021*005010X223A2~
BHT*0019*00*000004*20260722*1830*CH~
NM1*41*2*HOMECENTRIS HEALTHCARE LLC*****46*833992125~
PER*IC*MATT AUMAN*TE*4103218448~
NM1*40*2*KAISER MEDICAID*****46*10403~
HL*1**20*1~
PRV*BI*PXC*251E00000X~
NM1*85*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
N3*10 CROSSROADS DRIVE, SUITE 102~
N4*OWINGS MILLS*MD*211178284~
REF*EI*833992125~
PER*IC*MATT AUMAN*TE*4103218448~
HL*2*1*22*0~
SBR*P*18*******CI~
NM1*IL*1*KATSIKADAKOS*DIMITRIS****MI*94207215~
N3*5005 SAINT PAUL CHURCH RD~
N4*PYLESVILLE*MD*21132~
DMG*D8*19811227*M~
NM1*PR*2*KAISER MEDICAID*****PI*10403~
N3*10 CROSSROADS DRIVE SUITE 102~
N4*OWINGS MILLS*MD*211179999~
CLM*1150-260722183021*2100***32>A>1**A*Y*Y*********~
DTP*434*RD8*20260406-20260421~
DTP*435*DT*202604060001~
CL1*9*4*30~
REF*G1*1720740446-1~
HI*ABK>T86821~
HI*ABF>F419*ABF>Z87891*ABF>Z98890~
HI*BH>50>D8>20260406~
NM1*71*1*GAO*QINGLIN****XX*1053381780~
LX*1~
SV2*0551*HC>G0299*700.00*UN*1~
DTP*472*D8*20260406~
LX*2~
SV2*0551*HC>G0299*700.00*UN*1~
DTP*472*D8*20260414~
LX*3~
SV2*0551*HC>G0299*700.00*UN*1~
DTP*472*D8*20260421~
SE*40*183021~
GE*1*3021~
IEA*1*722183021~