ISA|00| |00| |ZZ|ZIRMED |ZZ|947971C9807506 |250922|2320|}|00501|000003429|0|P|^~GS|HP|ZIRMED|947971C9807506|20250922|2320|3429|X|005010X221A1~ST|835|0001~BPR|I|17848.45|C|ACH|CCP|01|031100209|DA|38876542|1520954463||01|055002338|DA|93128821|20250922~TRN|1|000001850769050|1520954463~DTM|405|20250922~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|1150-250915172720|1|700|139||HM|174377142|32|3~NM1|QC|1|RIDDICK|SHARON||||MI|24110037~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|24110037~REF|G1|1720001655~DTM|232|20250729~DTM|233|20250729~DTM|050|20250916~AMT|AU|700~SVC|HC^G0151|700|139|0421~DTM|472|20250729~CAS|CO|45|561~REF|6R|10577098755Z1~AMT|B6|139~CLP|1150-250915172923|1|700|139||HM|174377143|32|3~NM1|QC|1|TERRY JR|GEORGE||||MI|36110654~NM1|74|1|TERRY||A~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|36110654~REF|G1|1719771163~DTM|232|20250728~DTM|233|20250728~DTM|050|20250916~AMT|AU|700~SVC|HC^G0151|700|139|0421~DTM|472|20250728~CAS|CO|45|561~REF|6R|10577110152Z1~AMT|B6|139~CLP|1150-250915153318|1|5600.01|2131.08||MA|174378373|32|9~NM1|QC|1|HURTT|NOLAN||||MI|52110830~NM1|74|1|||E~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|52110830~REF|G1|1720030145~DTM|232|20250813~DTM|233|20250825~DTM|050|20250916~AMT|AU|5600.01~SVC|HC^1EB11|0|2131.08|0023~DTM|472|20250813~CAS|CO|45|-2174.57||253|43.49~REF|6R|10576571772Z1~AMT|B6|2174.57~LQ|HE|N669~SVC|HC^Q5001|.01|0|0551|0~DTM|472|20250813~CAS|CO|45|.01~REF|6R|10576571772Z2~SVC|HC^G0299|700|0|0551|0~DTM|472|20250813~CAS|CO|45|700~REF|6R|10576571772Z3~SVC|HC^G0151|700|0|0421|0~DTM|472|20250813~CAS|CO|45|700~REF|6R|10576571772Z4~SVC|HC^G0151|700|0|0421|0~DTM|472|20250815~CAS|CO|45|700~REF|6R|10576571772Z5~SVC|HC^G0151|700|0|0421|0~DTM|472|20250818~CAS|CO|45|700~REF|6R|10576571772Z6~SVC|HC^G0299|700|0|0551|0~DTM|472|20250818~CAS|CO|45|700~REF|6R|10576571772Z7~SVC|HC^G0151|700|0|0421|0~DTM|472|20250820~CAS|CO|45|700~REF|6R|10576571772Z8~SVC|HC^G0151|700|0|0421|0~DTM|472|20250822~CAS|CO|45|700~REF|6R|10576571772Z9~SVC|HC^G0151|700|0|0421|0~DTM|472|20250825~CAS|CO|45|700~REF|6R|10576571772Z10~CLP|1150-250915160609|1|5600|1072||HM|174377132|32|1~NM1|QC|1|DE GUZMAN|FRANCISCO||||MI|151085346~NM1|74|1|||L~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|151085346~REF|G1|1720008975~DTM|232|20250814~DTM|233|20250827~DTM|050|20250916~AMT|AU|5600~SVC|HC^G0299|700|119|0551~DTM|472|20250814~CAS|CO|45|581~REF|6R|10576734292Z1~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20250814~CAS|CO|45|561~REF|6R|10576734292Z2~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250818~CAS|CO|45|561~REF|6R|10576734292Z3~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250820~CAS|CO|45|561~REF|6R|10576734292Z4~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20250820~CAS|CO|45|581~REF|6R|10576734292Z5~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20250822~CAS|CO|45|561~REF|6R|10576734292Z6~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250825~CAS|CO|45|561~REF|6R|10576734292Z7~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250827~CAS|CO|45|561~REF|6R|10576734292Z8~AMT|B6|139~CLP|1150-250915162218|1|5600|1072||HM|174377135|32|1~NM1|QC|1|LANG|DARLENE||||MI|321043153~NM1|74|1|||M~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|321043153~REF|G1|1720041739~DTM|232|20250823~DTM|233|20250905~DTM|050|20250916~AMT|AU|5600~SVC|HC^G0299|700|119|0551~DTM|472|20250823~CAS|CO|45|581~REF|6R|10576800313Z1~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20250825~CAS|CO|45|561~REF|6R|10576800313Z2~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250826~CAS|CO|45|561~REF|6R|10576800313Z3~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20250828~CAS|CO|45|581~REF|6R|10576800313Z4~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20250828~CAS|CO|45|561~REF|6R|10576800313Z5~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250902~CAS|CO|45|561~REF|6R|10576800313Z6~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250904~CAS|CO|45|561~REF|6R|10576800313Z7~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250905~CAS|CO|45|561~REF|6R|10576800313Z8~AMT|B6|139~CLP|1150-250915130732|1|700|139||HM|174377125|32|3~NM1|QC|1|SNAPE|BRITTANY||||MI|471095175~NM1|74|1|||T~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|471095175~REF|G1|1719935554~DTM|232|20250709~DTM|233|20250709~DTM|050|20250916~AMT|AU|700~SVC|HC^G0151|700|139|0421~DTM|472|20250709~CAS|CO|45|561~REF|6R|10575799011Z1~AMT|B6|139~CLP|1150-250915131644|1|700|139||HM|174377126|32|3~NM1|QC|1|MARTIN|JOHN||||MI|561103796~NM1|74|1|MARTIN III||Q~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|561103796~REF|G1|1719954366~DTM|232|20250710~DTM|233|20250710~DTM|050|20250916~AMT|AU|700~SVC|HC^G0151|700|139|0421~DTM|472|20250710~CAS|CO|45|561~REF|6R|10575835406Z1~AMT|B6|139~CLP|1150-250915132453|1|700|139||HM|174377128|32|3~NM1|QC|1|REKUS|MARY||||MI|691028281~NM1|74|1|||T~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|691028281~REF|G1|1719927624~DTM|232|20250710~DTM|233|20250710~DTM|050|20250916~AMT|AU|700~SVC|HC^G0151|700|139|0421~DTM|472|20250710~CAS|CO|45|561~REF|6R|10575868358Z1~AMT|B6|139~CLP|1150-250915130128|1|700|139||HM|174377122|32|3~NM1|QC|1|NUWORSOO|ELIZABETH||||MI|99236736~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|99236736~REF|G1|1719887854~DTM|232|20250623~DTM|233|20250623~DTM|050|20250916~AMT|AU|700~SVC|HC^G0151|700|139|0421~DTM|472|20250623~CAS|CO|45|561~REF|6R|10575763786Z1~AMT|B6|139~CLP|1150-250915161206|1|5600|1072||15|174377133|32|1~NM1|QC|1|SIMMONS|RYAN||||MI|46270483~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|46270483~REF|G1|1720001666~DTM|232|20250808~DTM|233|20250821~DTM|050|20250916~AMT|AU|5600~SVC|HC^G0299|700|119|0551~DTM|472|20250808~CAS|CO|45|581~REF|6R|10576758820Z1~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20250808~CAS|CO|45|561~REF|6R|10576758820Z2~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250811~CAS|CO|45|561~REF|6R|10576758820Z3~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250813~CAS|CO|45|561~REF|6R|10576758820Z4~AMT|B6|139~SVC|HC^G0157|700|139|0421~DTM|472|20250814~CAS|CO|45|561~REF|6R|10576758820Z5~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20250815~CAS|CO|45|581~REF|6R|10576758820Z6~AMT|B6|119~SVC|HC^G0157|700|139|0421~DTM|472|20250818~CAS|CO|45|561~REF|6R|10576758820Z7~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250821~CAS|CO|45|561~REF|6R|10576758820Z8~AMT|B6|139~CLP|1150-250915171926|1|700|139||15|174377141|32|3~NM1|QC|1|SIMMONS|RYAN||||MI|46270483~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|46270483~REF|G1|1720001677~DTM|232|20250728~DTM|233|20250728~DTM|050|20250916~AMT|AU|700~SVC|HC^G0151|700|139|0421~DTM|472|20250728~CAS|CO|45|561~REF|6R|10577077941Z1~AMT|B6|139~CLP|1150-250915155200|1|5600.01|2088.96||MA|174378377|32|9~NM1|QC|1|RATTINI|CARLA||||MI|53309984~NM1|74|1|||M~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|53309984~REF|G1|1720008988~DTM|232|20250813~DTM|233|20250825~DTM|050|20250916~AMT|AU|5600.01~SVC|HC^1EA21|0|2088.96|0023~DTM|472|20250813~CAS|CO|45|-2131.59||253|42.63~REF|6R|10576668946Z1~AMT|B6|2131.59~LQ|HE|N669~SVC|HC^Q5001|.01|0|0551|0~DTM|472|20250813~CAS|CO|45|.01~REF|6R|10576668946Z2~SVC|HC^G0299|700|0|0551|0~DTM|472|20250813~CAS|CO|45|700~REF|6R|10576668946Z3~SVC|HC^G0151|700|0|0421|0~DTM|472|20250813~CAS|CO|45|700~REF|6R|10576668946Z4~SVC|HC^G0157|700|0|0421|0~DTM|472|20250815~CAS|CO|45|700~REF|6R|10576668946Z5~SVC|HC^G0157|700|0|0421|0~DTM|472|20250818~CAS|CO|45|700~REF|6R|10576668946Z6~SVC|HC^G0299|700|0|0551|0~DTM|472|20250819~CAS|CO|45|700~REF|6R|10576668946Z7~SVC|HC^G0157|700|0|0421|0~DTM|472|20250821~CAS|CO|45|700~REF|6R|10576668946Z8~SVC|HC^G0151|700|0|0421|0~DTM|472|20250822~CAS|CO|45|700~REF|6R|10576668946Z9~SVC|HC^G0151|700|0|0421|0~DTM|472|20250825~CAS|CO|45|700~REF|6R|10576668946Z10~CLP|1150-250915143126|1|700.01|188.59||MA|174378368|32|9~NM1|QC|1|BALAREZO|SILVIA||||MI|27324412~NM1|74|1|||D~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|27324412~REF|G1|1719970487~DTM|232|20250902~DTM|233|20250902~DTM|050|20250916~AMT|AU|700.01~SVC|HC^3EC21|0|188.59|0023~DTM|472|20250902~CAS|CO|45|-192.44||253|3.85~REF|6R|10576238224Z1~AMT|B6|192.44~LQ|HE|N669~SVC|HC^Q5001|.01|0|0421|0~DTM|472|20250902~CAS|CO|45|.01~REF|6R|10576238224Z2~SVC|HC^G0151|700|0|0421|0~DTM|472|20250902~CAS|CO|45|700~REF|6R|10576238224Z3~CLP|1150-250915143013|1|9800.01|2546.2||MA|174378369|32|9~NM1|QC|1|BALAREZO|SILVIA||||MI|27324412~NM1|74|1|||D~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|27324412~REF|G1|1719970487~DTM|232|20250730~DTM|233|20250828~DTM|050|20250916~AMT|AU|9800.01~SVC|HC^1EC21|0|2546.2|0023~DTM|472|20250730~CAS|CO|45|-2598.16||253|51.96~REF|6R|10576246574Z1~AMT|B6|2598.16~LQ|HE|N669~SVC|HC^Q5001|.01|0|0551|0~DTM|472|20250730~CAS|CO|45|.01~REF|6R|10576246574Z2~SVC|HC^G0299|700|0|0551|0~DTM|472|20250730~CAS|CO|45|700~REF|6R|10576246574Z3~SVC|HC^G0151|700|0|0421|0~DTM|472|20250730~CAS|CO|45|700~REF|6R|10576246574Z4~SVC|HC^G0151|700|0|0421|0~DTM|472|20250801~CAS|CO|45|700~REF|6R|10576246574Z5~SVC|HC^G0151|700|0|0421|0~DTM|472|20250804~CAS|CO|45|700~REF|6R|10576246574Z6~SVC|HC^G0151|700|0|0421|0~DTM|472|20250805~CAS|CO|45|700~REF|6R|10576246574Z7~SVC|HC^G0299|700|0|0551|0~DTM|472|20250807~CAS|CO|45|700~REF|6R|10576246574Z8~SVC|HC^G0151|700|0|0421|0~DTM|472|20250811~CAS|CO|45|700~REF|6R|10576246574Z9~SVC|HC^G0151|700|0|0421|0~DTM|472|20250812~CAS|CO|45|700~REF|6R|10576246574Z10~SVC|HC^G0299|700|0|0551|0~DTM|472|20250813~CAS|CO|45|700~REF|6R|10576246574Z11~SVC|HC^G0151|700|0|0421|0~DTM|472|20250818~CAS|CO|45|700~REF|6R|10576246574Z12~SVC|HC^G0151|700|0|0421|0~DTM|472|20250820~CAS|CO|45|700~REF|6R|10576246574Z13~SVC|HC^G0299|700|0|0551|0~DTM|472|20250821~CAS|CO|45|700~REF|6R|10576246574Z14~SVC|HC^G0151|700|0|0421|0~DTM|472|20250828~CAS|CO|45|700~REF|6R|10576246574Z15~SVC|HC^G0299|700|0|0551|0~DTM|472|20250828~CAS|CO|45|700~REF|6R|10576246574Z16~CLP|1150-250915154114|1|5600.01|2258.9||MA|174378375|32|9~NM1|QC|1|PROSSER|ANNE||||MI|59145795~NM1|74|1|||M~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|59145795~REF|G1|1719682582~DTM|232|20250818~DTM|233|20250829~DTM|050|20250916~AMT|AU|5600.01~SVC|HC^1EB21|0|2258.9|0023~DTM|472|20250818~CAS|CO|45|-2305||253|46.1~REF|6R|10576636366Z1~AMT|B6|2305~LQ|HE|N669~SVC|HC^Q5001|.01|0|0551|0~DTM|472|20250818~CAS|CO|45|.01~REF|6R|10576636366Z2~SVC|HC^G0299|700|0|0551|0~DTM|472|20250818~CAS|CO|45|700~REF|6R|10576636366Z3~SVC|HC^G0151|700|0|0421|0~DTM|472|20250818~CAS|CO|45|700~REF|6R|10576636366Z4~SVC|HC^G0151|700|0|0421|0~DTM|472|20250819~CAS|CO|45|700~REF|6R|10576636366Z5~SVC|HC^G0151|700|0|0421|0~DTM|472|20250821~CAS|CO|45|700~REF|6R|10576636366Z6~SVC|HC^G0299|700|0|0551|0~DTM|472|20250825~CAS|CO|45|700~REF|6R|10576636366Z7~SVC|HC^G0151|700|0|0421|0~DTM|472|20250825~CAS|CO|45|700~REF|6R|10576636366Z8~SVC|HC^G0151|700|0|0421|0~DTM|472|20250827~CAS|CO|45|700~REF|6R|10576636366Z9~SVC|HC^G0151|700|0|0421|0~DTM|472|20250829~CAS|CO|45|700~REF|6R|10576636366Z10~CLP|1150-250915163321|1|5600|1072||HM|174377136|32|1~NM1|QC|1|POWELL|JOHN||||MI|911303732~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|911303732~REF|G1|1720041457~DTM|232|20250822~DTM|233|20250904~DTM|050|20250916~AMT|AU|5600~SVC|HC^G0299|700|119|0551~DTM|472|20250822~CAS|CO|45|581~REF|6R|10576841579Z1~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20250822~CAS|CO|45|561~REF|6R|10576841579Z2~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250825~CAS|CO|45|561~REF|6R|10576841579Z3~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250827~CAS|CO|45|561~REF|6R|10576841579Z4~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250828~CAS|CO|45|561~REF|6R|10576841579Z5~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20250829~CAS|CO|45|581~REF|6R|10576841579Z6~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20250902~CAS|CO|45|561~REF|6R|10576841579Z7~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250904~CAS|CO|45|561~REF|6R|10576841579Z8~AMT|B6|139~CLP|1150-250915155831|1|4200.01|1994.83||MA|174378378|32|9~NM1|QC|1|WATERS-BEY|MICHAEL||||MI|57196155~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|57196155~REF|G1|1719847050~DTM|232|20250729~DTM|233|20250821~DTM|050|20250916~AMT|AU|4200.01~SVC|HC^3AC31|0|1994.83|0023~DTM|472|20250729~CAS|CO|45|-2035.54||253|40.71~REF|6R|10576701043Z1~AMT|B6|2035.54~LQ|HE|N669~SVC|HC^Q5001|.01|0|0421|0~DTM|472|20250729~CAS|CO|45|.01~REF|6R|10576701043Z2~SVC|HC^G0151|700|0|0421|0~DTM|472|20250729~CAS|CO|45|700~REF|6R|10576701043Z3~SVC|HC^G0152|700|0|0431|0~DTM|472|20250730~CAS|CO|45|700~REF|6R|10576701043Z4~SVC|HC^G0151|700|0|0421|0~DTM|472|20250807~CAS|CO|45|700~REF|6R|10576701043Z5~SVC|HC^G0151|700|0|0421|0~DTM|472|20250812~CAS|CO|45|700~REF|6R|10576701043Z6~SVC|HC^G0151|700|0|0421|0~DTM|472|20250819~CAS|CO|45|700~REF|6R|10576701043Z7~SVC|HC^G0151|700|0|0421|0~DTM|472|20250821~CAS|CO|45|700~REF|6R|10576701043Z8~CLP|1150-250915164839|1|5600|1072||HM|174377138|32|1~NM1|QC|1|JOHNSON|DARRYL||||MI|11203823~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|11203823~REF|G1|1720042369~DTM|232|20250826~DTM|233|20250905~DTM|050|20250916~AMT|AU|5600~SVC|HC^G0299|700|119|0551~DTM|472|20250826~CAS|CO|45|581~REF|6R|10576911986Z1~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20250826~CAS|CO|45|561~REF|6R|10576911986Z2~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250827~CAS|CO|45|561~REF|6R|10576911986Z3~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250829~CAS|CO|45|561~REF|6R|10576911986Z4~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20250901~CAS|CO|45|581~REF|6R|10576911986Z5~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20250902~CAS|CO|45|561~REF|6R|10576911986Z6~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250903~CAS|CO|45|561~REF|6R|10576911986Z7~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250905~CAS|CO|45|561~REF|6R|10576911986Z8~AMT|B6|139~CLP|1150-250915132750|1|700|139||HM|174377130|32|3~NM1|QC|1|FUENTES|ANGEL||||MI|37205608~NM1|74|1|||R~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|37205608~REF|G1|1719963127~DTM|232|20250725~DTM|233|20250725~DTM|050|20250916~AMT|AU|700~SVC|HC^G0151|700|139|0421~DTM|472|20250725~CAS|CO|45|561~REF|6R|10575886600Z1~AMT|B6|139~CLP|1150-250915133254|1|700|167.89||HM|174377769|32|3~NM1|QC|1|MORA SUSA|MARIA||||MI|17205930~NM1|74|1|||E~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|17205930~REF|G1|1720001703~DTM|232|20250728~DTM|233|20250728~DTM|050|20250916~AMT|AU|700~SVC|HC^G0151|700|167.89|0421~DTM|472|20250728~CAS|CO|45|532.11~REF|6R|10575902566Z1~AMT|B6|167.89~SE|693|0001~GE|1|3429~IEA|1|000003429~