ISA|00| |00| |ZZ|ZIRMED |ZZ|947971C9807506 |251007|0110|}|00501|000003438|0|P|^~GS|HP|ZIRMED|947971C9807506|20251007|0110|3438|X|005010X221A1~ST|835|0001~BPR|I|9624.23|C|ACH|CCP|01|031100209|DA|38876542|1520954463||01|055002338|DA|93128821|20251007~TRN|1|000001850774104|1520954463~DTM|405|20251007~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|1150-250930164603|1|4200|834||HM|175276156|32|4~NM1|QC|1|WILLIAMS|PATSY||||MI|181126999~NM1|74|1|||A~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|181126999~REF|G1|1720020199~DTM|232|20250904~DTM|233|20250924~DTM|050|20251001~AMT|AU|4200~SVC|HC^G0157|700|139|0421~DTM|472|20250904~CAS|CO|45|561~REF|6R|10661865476Z1~AMT|B6|139~SVC|HC^G0152|700|139|0431~DTM|472|20250904~CAS|CO|45|561~REF|6R|10661865476Z2~AMT|B6|139~SVC|HC^G0152|700|139|0431~DTM|472|20250910~CAS|CO|45|561~REF|6R|10661865476Z3~AMT|B6|139~SVC|HC^G0157|700|139|0421~DTM|472|20250910~CAS|CO|45|561~REF|6R|10661865476Z4~AMT|B6|139~SVC|HC^G0157|700|139|0421~DTM|472|20250917~CAS|CO|45|561~REF|6R|10661865476Z5~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20250924~CAS|CO|45|561~REF|6R|10661865476Z6~AMT|B6|139~CLP|1150-250930153611|1|7700.01|0||MA|175277304|32|9~NM1|QC|1|SCHIELD|JOSEPH||||MI|421282542~NM1|74|1|||E~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|421282542~REF|G1|1720105899~DTM|232|20250831~DTM|233|20250926~DTM|050|20251001~AMT|AU|7700.01~SVC|HC^2HA21|0|0|0023|0~DTM|472|20250831~REF|6R|10661565871Z1~LQ|HE|N669~SVC|HC^Q5001|.01|0|0551|0~DTM|472|20250831~CAS|PI|16|.01~REF|6R|10661565871Z2~LQ|HE|M50~SVC|HC^G0299|700|0|0551|0~DTM|472|20250831~CAS|PI|16|700~REF|6R|10661565871Z3~LQ|HE|M50~SVC|HC^G0151|700|0|0421|0~DTM|472|20250903~CAS|PI|16|700~REF|6R|10661565871Z4~LQ|HE|M50~SVC|HC^G0152|700|0|0431|0~DTM|472|20250904~CAS|PI|16|700~REF|6R|10661565871Z5~LQ|HE|M50~SVC|HC^G0157|700|0|0421|0~DTM|472|20250909~CAS|PI|16|700~REF|6R|10661565871Z6~LQ|HE|M50~SVC|HC^G0299|700|0|0551|0~DTM|472|20250911~CAS|PI|16|700~REF|6R|10661565871Z7~LQ|HE|M50~SVC|HC^G0157|700|0|0421|0~DTM|472|20250911~CAS|PI|16|700~REF|6R|10661565871Z8~LQ|HE|M50~SVC|HC^G0157|700|0|0421|0~DTM|472|20250916~CAS|PI|16|700~REF|6R|10661565871Z9~LQ|HE|M50~SVC|HC^G0299|700|0|0551|0~DTM|472|20250918~CAS|PI|16|700~REF|6R|10661565871Z10~LQ|HE|M50~SVC|HC^G0157|700|0|0421|0~DTM|472|20250918~CAS|PI|16|700~REF|6R|10661565871Z11~LQ|HE|M50~SVC|HC^G0157|700|0|0421|0~DTM|472|20250924~CAS|PI|16|700~REF|6R|10661565871Z12~LQ|HE|M50~SVC|HC^G0157|700|0|0421|0~DTM|472|20250926~CAS|PI|16|700~REF|6R|10661565871Z13~LQ|HE|M50~CLP|1150-250930150702|1|5600.01|1961.14||MA|175277303|32|9~NM1|QC|1|MURPHY|LINDA||||MI|29225553~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|29225553~REF|G1|1720078137~DTM|232|20250909~DTM|233|20250923~DTM|050|20251001~AMT|AU|5600.01~SVC|HC^1EA11|0|1961.14|0023~DTM|472|20250909~CAS|CO|45|-2001.16||253|40.02~REF|6R|10661437828Z1~AMT|B6|2001.16~LQ|HE|N669~SVC|HC^Q5001|.01|0|0551|0~DTM|472|20250909~CAS|CO|45|.01~REF|6R|10661437828Z2~SVC|HC^G0299|700|0|0551|0~DTM|472|20250909~CAS|CO|45|700~REF|6R|10661437828Z3~SVC|HC^G0151|700|0|0421|0~DTM|472|20250909~CAS|CO|45|700~REF|6R|10661437828Z4~SVC|HC^G0151|700|0|0421|0~DTM|472|20250911~CAS|CO|45|700~REF|6R|10661437828Z5~SVC|HC^G0151|700|0|0421|0~DTM|472|20250915~CAS|CO|45|700~REF|6R|10661437828Z6~SVC|HC^G0299|700|0|0551|0~DTM|472|20250915~CAS|CO|45|700~REF|6R|10661437828Z7~SVC|HC^G0151|700|0|0421|0~DTM|472|20250916~CAS|CO|45|700~REF|6R|10661437828Z8~SVC|HC^G0151|700|0|0421|0~DTM|472|20250918~CAS|CO|45|700~REF|6R|10661437828Z9~SVC|HC^G0151|700|0|0421|0~DTM|472|20250923~CAS|CO|45|700~REF|6R|10661437828Z10~CLP|1150-250930163825|1|4200|0|834|HM|175276154|32|1~NM1|QC|1|KHAREBAVA|IRINE||||MI|76239845~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|76239845~REF|G1|1720109285~DTM|232|20250903~DTM|233|20250923~DTM|050|20251001~AMT|AU|4200~SVC|HC^G0151|700|0|0421|0~DTM|472|20250903~CAS|CO|45|561~CAS|PR|1|139~REF|6R|10661834088Z1~AMT|B6|139~SVC|HC^G0151|700|0|0421|0~DTM|472|20250909~CAS|CO|45|561~CAS|PR|1|139~REF|6R|10661834088Z2~AMT|B6|139~SVC|HC^G0151|700|0|0421|0~DTM|472|20250911~CAS|CO|45|561~CAS|PR|1|139~REF|6R|10661834088Z3~AMT|B6|139~SVC|HC^G0151|700|0|0421|0~DTM|472|20250916~CAS|CO|45|561~CAS|PR|1|139~REF|6R|10661834088Z4~AMT|B6|139~SVC|HC^G0151|700|0|0421|0~DTM|472|20250917~CAS|CO|45|561~CAS|PR|1|139~REF|6R|10661834088Z5~AMT|B6|139~SVC|HC^G0151|700|0|0421|0~DTM|472|20250923~CAS|CO|45|561~CAS|PR|1|139~REF|6R|10661834088Z6~AMT|B6|139~CLP|1150-250930134946|1|6300.01|2768.75||MA|175277298|32|9~NM1|QC|1|FISCHER|FREDERICK||||MI|76164347~NM1|74|1|FISCHER JR||V~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|76164347~REF|G1|1720059184~DTM|232|20250812~DTM|233|20250909~DTM|050|20251001~AMT|AU|6300.01~SVC|HC^1CA21|0|2768.75|0023~DTM|472|20250812~CAS|CO|45|-2825.26||253|56.51~REF|6R|10661050638Z1~AMT|B6|2825.26~LQ|HE|N669~SVC|HC^Q5001|.01|0|0551|0~DTM|472|20250812~CAS|CO|45|.01~REF|6R|10661050638Z2~SVC|HC^G0299|700|0|0551|0~DTM|472|20250812~CAS|CO|45|700~REF|6R|10661050638Z3~SVC|HC^G0151|700|0|0421|0~DTM|472|20250814~CAS|CO|45|700~REF|6R|10661050638Z4~SVC|HC^G0152|700|0|0431|0~DTM|472|20250814~CAS|CO|45|700~REF|6R|10661050638Z5~SVC|HC^G0299|700|0|0551|0~DTM|472|20250820~CAS|CO|45|700~REF|6R|10661050638Z6~SVC|HC^G0299|700|0|0551|0~DTM|472|20250822~CAS|CO|45|700~REF|6R|10661050638Z7~SVC|HC^G0299|700|0|0551|0~DTM|472|20250829~CAS|CO|45|700~REF|6R|10661050638Z8~SVC|HC^G0299|700|0|0551|0~DTM|472|20250902~CAS|CO|45|700~REF|6R|10661050638Z9~SVC|HC^G0299|700|0|0551|0~DTM|472|20250905~CAS|CO|45|700~REF|6R|10661050638Z10~SVC|HC^G0299|700|0|0551|0~DTM|472|20250909~CAS|CO|45|700~REF|6R|10661050638Z11~CLP|1150-250930145627|1|6300.01|2360.01||MA|175277302|32|9~NM1|QC|1|MAUZONE|JUANITA||||MI|17166781~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|17166781~REF|G1|1719990232~DTM|232|20250826~DTM|233|20250918~DTM|050|20251001~AMT|AU|6300.01~SVC|HC^3CA31|0|2360.01|0023~DTM|472|20250826~CAS|CO|45|-2408.17||253|48.16~REF|6R|10661374091Z1~AMT|B6|2408.17~LQ|HE|N669~SVC|HC^Q5001|.01|0|0551|0~DTM|472|20250826~CAS|CO|45|.01~REF|6R|10661374091Z2~SVC|HC^G0299|700|0|0551|0~DTM|472|20250826~CAS|CO|45|700~REF|6R|10661374091Z3~SVC|HC^G0299|700|0|0551|0~DTM|472|20250828~CAS|CO|45|700~REF|6R|10661374091Z4~SVC|HC^G0152|700|0|0431|0~DTM|472|20250829~CAS|CO|45|700~REF|6R|10661374091Z5~SVC|HC^G0299|700|0|0551|0~DTM|472|20250902~CAS|CO|45|700~REF|6R|10661374091Z6~SVC|HC^G0152|700|0|0431|0~DTM|472|20250904~CAS|CO|45|700~REF|6R|10661374091Z7~SVC|HC^G0299|700|0|0551|0~DTM|472|20250904~CAS|CO|45|700~REF|6R|10661374091Z8~SVC|HC^G0299|700|0|0551|0~DTM|472|20250911~CAS|CO|45|700~REF|6R|10661374091Z9~SVC|HC^G0299|700|0|0551|0~DTM|472|20250916~CAS|CO|45|700~REF|6R|10661374091Z10~SVC|HC^G0299|700|0|0551|0~DTM|472|20250918~CAS|CO|45|700~REF|6R|10661374091Z11~CLP|1150-250930144724|1|4900.01|1700.33||MA|175277300|32|9~NM1|QC|1|LOVE|JACK||||MI|42215273~NM1|74|1|||R~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|42215273~REF|G1|1719936904~DTM|232|20250829~DTM|233|20250915~DTM|050|20251001~AMT|AU|4900.01~SVC|HC^3HC21|0|1700.33|0023~DTM|472|20250829~CAS|CO|45|-1735.03||253|34.7~REF|6R|10661341745Z1~AMT|B6|1735.03~LQ|HE|N669~SVC|HC^Q5001|.01|0|0431|0~DTM|472|20250829~CAS|CO|45|.01~REF|6R|10661341745Z2~SVC|HC^G0152|700|0|0431|0~DTM|472|20250829~CAS|CO|45|700~REF|6R|10661341745Z3~SVC|HC^G0299|700|0|0551|0~DTM|472|20250829~CAS|CO|45|700~REF|6R|10661341745Z4~SVC|HC^G0151|700|0|0421|0~DTM|472|20250903~CAS|CO|45|700~REF|6R|10661341745Z5~SVC|HC^G0152|700|0|0431|0~DTM|472|20250905~CAS|CO|45|700~REF|6R|10661341745Z6~SVC|HC^G0151|700|0|0421|0~DTM|472|20250908~CAS|CO|45|700~REF|6R|10661341745Z7~SVC|HC^G0151|700|0|0421|0~DTM|472|20250910~CAS|CO|45|700~REF|6R|10661341745Z8~SVC|HC^G0151|700|0|0421|0~DTM|472|20250915~CAS|CO|45|700~REF|6R|10661341745Z9~SE|384|0001~GE|1|3438~IEA|1|000003438~