ISA|00| |00| |ZZ|ZIRMED |ZZ|923001C9807506 |250828|0503|}|00501|000003415|0|P|^~GS|HP|ZIRMED|923001C9807506|20250828|0503|3415|X|005010X221A1~ST|835|0001~BPR|I|9369.76|C|ACH|CCP|01|031100209|DA|38876542|1520954463||01|055002338|DA|93128821|20250828~TRN|1|000001850761396|1520954463~DTM|405|20250828~N1|PR|KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES~N3|PO BOX 64533~N4|BALTIMORE|MD|21264~PER|CX|EDICLAIMSNCSO|TE|8008132000|EM|EDICLAIMSNCSO@KP.ORG~PER|BL|NEBO|EM|NEHBO@KP.ORG~N1|PE|HOMECENTRIS HOME HEALTH II LLC|XX|1487113239~N3|10 CROSSROADS DR STE 110~N4|OWINGS MILLS|MD|211175464~REF|TJ|833992125~LX|1~CLP|1150-250821170251|1|700|167.89||HM|172791017|32|4~NM1|QC|1|ROSEBOROUGH|MELISSA||||MI|821077603~NM1|74|1|||L~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|821077603~REF|G1|1719941067~DTM|232|20250723~DTM|233|20250723~DTM|050|20250822~AMT|AU|700~SVC|HC^G0151|700|167.89|0421~DTM|472|20250723~CAS|CO|45|532.11~REF|6R|10441284890Z1~AMT|B6|167.89~CLP|1150-250821170742|1|2100|465.81||HM|172791019|32|3~NM1|QC|1|JOHNSON|TAWANA||||MI|37224540~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|37224540~REF|G1|1719825098~DTM|232|20250721~DTM|233|20250808~DTM|050|20250822~AMT|AU|2100~SVC|HC^G0299|700|155.27|0551~DTM|472|20250721~CAS|CO|45|544.73~REF|6R|10441313388Z1~AMT|B6|155.27~SVC|HC^G0299|700|155.27|0551~DTM|472|20250728~CAS|CO|45|544.73~REF|6R|10441313388Z2~AMT|B6|155.27~SVC|HC^G0299|700|155.27|0551~DTM|472|20250808~CAS|CO|45|544.73~REF|6R|10441313388Z3~AMT|B6|155.27~CLP|1150-250821165542|1|700|155.27||HM|172791018|32|4~NM1|QC|1|MENDEL|JOSEPH||||MI|92241569~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|92241569~REF|G1|1719902359~DTM|232|20250722~DTM|233|20250722~DTM|050|20250822~AMT|AU|700~SVC|HC^G0299|700|155.27|0551~DTM|472|20250722~CAS|CO|45|544.73~REF|6R|10441253623Z1~AMT|B6|155.27~CLP|1150-250821144632|1|9800.01|2395.77||MA|172790878|32|9~NM1|QC|1|GILL|MARY||||MI|761422550~NM1|74|1|||F|||C|76142550~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|76142550~REF|G1|1719997286~DTM|232|20250721~DTM|233|20250811~DTM|050|20250822~AMT|AU|9800.01~SVC|HC^1EA31|0|2395.77|0023~DTM|472|20250721~CAS|CO|45|-2444.66||253|48.89~REF|6R|10440739515Z1~AMT|B6|2444.66~SVC|HC^Q5001|.01|0|0551|0~DTM|472|20250721~CAS|CO|45|.01~REF|6R|10440739515Z2~SVC|HC^G0299|700|0|0551|0~DTM|472|20250721~CAS|CO|45|700~REF|6R|10440739515Z3~SVC|HC^G0151|700|0|0421|0~DTM|472|20250724~CAS|CO|45|700~REF|6R|10440739515Z4~SVC|HC^G0299|700|0|0551|0~DTM|472|20250724~CAS|CO|45|700~REF|6R|10440739515Z5~SVC|HC^G0299|700|0|0551|0~DTM|472|20250728~CAS|CO|45|700~REF|6R|10440739515Z6~SVC|HC^G0151|700|0|0421|0~DTM|472|20250729~CAS|CO|45|700~REF|6R|10440739515Z7~SVC|HC^G0152|700|0|0431|0~DTM|472|20250730~CAS|CO|45|700~REF|6R|10440739515Z8~SVC|HC^G0151|700|0|0421|0~DTM|472|20250801~CAS|CO|45|700~REF|6R|10440739515Z9~SVC|HC^G0299|700|0|0551|0~DTM|472|20250804~CAS|CO|45|700~REF|6R|10440739515Z10~SVC|HC^G0152|700|0|0431|0~DTM|472|20250804~CAS|CO|45|700~REF|6R|10440739515Z11~SVC|HC^G0151|700|0|0421|0~DTM|472|20250805~CAS|CO|45|700~REF|6R|10440739515Z12~SVC|HC^G0299|700|0|0551|0~DTM|472|20250806~CAS|CO|45|700~REF|6R|10440739515Z13~SVC|HC^G0151|700|0|0421|0~DTM|472|20250807~CAS|CO|45|700~REF|6R|10440739515Z14~SVC|HC^G0299|700|0|0551|0~DTM|472|20250811~CAS|CO|45|700~REF|6R|10440739515Z15~SVC|HC^G0151|700|0|0421|0~DTM|472|20250811~CAS|CO|45|700~REF|6R|10440739515Z16~CLP|1150-250821125516|1|5600.01|2546.2||MA|172791137|32|9~NM1|QC|1|COOL|FLORENCE||||MI|96163252~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|96163252~REF|G1|1719946929~DTM|232|20250719~DTM|233|20250813~DTM|050|20250822~AMT|AU|5600.01~SVC|HC^1EC21|0|2546.2|0023~DTM|472|20250719~CAS|CO|45|-2598.16||253|51.96~REF|6R|10440289686Z1~AMT|B6|2598.16~SVC|HC^Q5001|.01|0|0551|0~DTM|472|20250719~CAS|CO|45|.01~REF|6R|10440289686Z2~SVC|HC^G0299|700|0|0551|0~DTM|472|20250719~CAS|CO|45|700~REF|6R|10440289686Z3~SVC|HC^G0151|700|0|0421|0~DTM|472|20250721~CAS|CO|45|700~REF|6R|10440289686Z4~SVC|HC^G0299|700|0|0551|0~DTM|472|20250723~CAS|CO|45|700~REF|6R|10440289686Z5~SVC|HC^G0157|700|0|0421|0~DTM|472|20250723~CAS|CO|45|700~REF|6R|10440289686Z6~SVC|HC^G0157|700|0|0421|0~DTM|472|20250724~CAS|CO|45|700~REF|6R|10440289686Z7~SVC|HC^G0157|700|0|0421|0~DTM|472|20250729~CAS|CO|45|700~REF|6R|10440289686Z8~SVC|HC^G0151|700|0|0421|0~DTM|472|20250805~CAS|CO|45|700~REF|6R|10440289686Z9~SVC|HC^G0151|700|0|0421|0~DTM|472|20250813~CAS|CO|45|700~REF|6R|10440289686Z10~CLP|1150-250821164229|1|2800|633.7||HM|172791016|32|3~NM1|QC|1|CHANG|CANDICE||||MI|85187624~NM1|74|1|||K~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|85187624~REF|G1|1719927157~DTM|232|20250724~DTM|233|20250804~DTM|050|20250822~AMT|AU|2800~SVC|HC^G0151|700|167.89|0421~DTM|472|20250724~CAS|CO|45|532.11~REF|6R|10441205939Z1~AMT|B6|167.89~SVC|HC^G0299|700|155.27|0551~DTM|472|20250728~CAS|CO|45|544.73~REF|6R|10441205939Z2~AMT|B6|155.27~SVC|HC^G0299|700|155.27|0551~DTM|472|20250731~CAS|CO|45|544.73~REF|6R|10441205939Z3~AMT|B6|155.27~SVC|HC^G0299|700|155.27|0551~DTM|472|20250804~CAS|CO|45|544.73~REF|6R|10441205939Z4~AMT|B6|155.27~CLP|1150-250821150321|1|8400.01|2015.78||MA|172791138|32|9~NM1|QC|1|HAWKINS|MILDRED||||MI|36209811~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|36209811~REF|G1|1719985133~DTM|232|20250717~DTM|233|20250811~DTM|050|20250822~AMT|AU|8400.01~SVC|HC^1LA21|0|2015.78|0023~DTM|472|20250717~CAS|CO|45|-2056.92||253|41.14~REF|6R|10440832042Z1~AMT|B6|2056.92~SVC|HC^Q5001|.01|0|0421|0~DTM|472|20250717~CAS|CO|45|.01~REF|6R|10440832042Z2~SVC|HC^G0151|700|0|0421|0~DTM|472|20250717~CAS|CO|45|700~REF|6R|10440832042Z3~SVC|HC^G0152|700|0|0431|0~DTM|472|20250721~CAS|CO|45|700~REF|6R|10440832042Z4~SVC|HC^G0157|700|0|0421|0~DTM|472|20250721~CAS|CO|45|700~REF|6R|10440832042Z5~SVC|HC^G0157|700|0|0421|0~DTM|472|20250723~CAS|CO|45|700~REF|6R|10440832042Z6~SVC|HC^G0152|700|0|0431|0~DTM|472|20250728~CAS|CO|45|700~REF|6R|10440832042Z7~SVC|HC^G0157|700|0|0421|0~DTM|472|20250729~CAS|CO|45|700~REF|6R|10440832042Z8~SVC|HC^G0152|700|0|0431|0~DTM|472|20250731~CAS|CO|45|700~REF|6R|10440832042Z9~SVC|HC^G0157|700|0|0421|0~DTM|472|20250802~CAS|CO|45|700~REF|6R|10440832042Z10~SVC|HC^G0152|700|0|0431|0~DTM|472|20250804~CAS|CO|45|700~REF|6R|10440832042Z11~SVC|HC^G0152|700|0|0431|0~DTM|472|20250807~CAS|CO|45|700~REF|6R|10440832042Z12~SVC|HC^G0157|700|0|0421|0~DTM|472|20250809~CAS|CO|45|700~REF|6R|10440832042Z13~SVC|HC^G0151|700|0|0421|0~DTM|472|20250811~CAS|CO|45|700~REF|6R|10440832042Z14~CLP|1150-250821171348|1|4200|989.34||HM|172791020|32|3~NM1|QC|1|PHILOGENE ABRAHAM|MARIECLAUDET||||MI|44221791~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|44221791~REF|G1|1719975629~DTM|232|20250801~DTM|233|20250814~DTM|050|20250822~AMT|AU|4200~SVC|HC^G0299|700|155.27|0551~DTM|472|20250801~CAS|CO|45|544.73~REF|6R|10441340538Z1~AMT|B6|155.27~SVC|HC^G0299|700|155.27|0551~DTM|472|20250807~CAS|CO|45|544.73~REF|6R|10441340538Z2~AMT|B6|155.27~SVC|HC^G0152|700|171.51|0431~DTM|472|20250807~CAS|CO|45|528.49~REF|6R|10441340538Z3~AMT|B6|171.51~SVC|HC^G0157|700|167.89|0421~DTM|472|20250807~CAS|CO|45|532.11~REF|6R|10441340538Z4~AMT|B6|167.89~SVC|HC^G0152|700|171.51|0431~DTM|472|20250814~CAS|CO|45|528.49~REF|6R|10441340538Z5~AMT|B6|171.51~SVC|HC^G0151|700|167.89|0421~DTM|472|20250814~CAS|CO|45|532.11~REF|6R|10441340538Z6~AMT|B6|167.89~SE|328|0001~GE|1|3415~IEA|1|000003415~