ISA|00| |00| |ZZ|ZIRMED |ZZ|947971C9807506 |251209|0042|}|00501|000003474|0|P|^~GS|HP|ZIRMED|947971C9807506|20251209|0042|3474|X|005010X221A1~ST|835|0001~BPR|I|5824.39|C|ACH|CCP|01|031100209|DA|38876542|1520954463||01|055002338|DA|93128821|20251209~TRN|1|000001850795764|1520954463~DTM|405|20251209~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|1150-251202142142|1|2100|377||HM|183288970|32|1~NM1|QC|1|FISHER|DENISE||||MI|28113005~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|28113005~REF|G1|1720336385~DTM|232|20251114~DTM|233|20251121~DTM|050|20251203~AMT|AU|2100~SVC|HC^G0299|700|119|0551~DTM|472|20251114~CAS|CO|45|581~REF|6R|11021704334Z1~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20251117~CAS|CO|45|561~REF|6R|11021704334Z2~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20251121~CAS|CO|45|581~REF|6R|11021704334Z3~AMT|B6|119~CLP|1150-251202144838|1|5600|980||HM|183288973|32|3~NM1|QC|1|LEVITT|JASON||||MI|69116927~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|69116927~REF|G1|1720276784~DTM|232|20251117~DTM|233|20251126~DTM|050|20251203~AMT|AU|5600~SVC|HC^G0152|700|139|0431~DTM|472|20251117~CAS|CO|45|561~REF|6R|11021854475Z1~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20251117~CAS|CO|45|561~REF|6R|11021854475Z2~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20251119~CAS|CO|45|561~REF|6R|11021854475Z3~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20251120~CAS|CO|45|581~REF|6R|11021854475Z4~AMT|B6|119~SVC|HC^G0152|700|139|0431~DTM|472|20251124~CAS|CO|45|561~REF|6R|11021854475Z5~AMT|B6|139~SVC|HC^G0156|700|47|0571~DTM|472|20251125~CAS|CO|45|653~REF|6R|11021854475Z6~AMT|B6|47~SVC|HC^G0299|700|119|0551~DTM|472|20251126~CAS|CO|45|581~REF|6R|11021854475Z7~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20251126~CAS|CO|45|561~REF|6R|11021854475Z8~AMT|B6|139~CLP|1150-251202151821|1|4200|774||HM|183288978|32|2~NM1|QC|1|SHEEDER|SELENA||||MI|19261411~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|19261411~REF|G1|1720343832~DTM|232|20251114~DTM|233|20251126~DTM|050|20251203~AMT|AU|4200~SVC|HC^G0299|700|119|0551~DTM|472|20251114~CAS|CO|45|581~REF|6R|11022022742Z1~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20251118~CAS|CO|45|561~REF|6R|11022022742Z2~AMT|B6|139~SVC|HC^G0152|700|139|0431~DTM|472|20251120~CAS|CO|45|561~REF|6R|11022022742Z3~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20251120~CAS|CO|45|581~REF|6R|11022022742Z4~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20251125~CAS|CO|45|561~REF|6R|11022022742Z5~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20251126~CAS|CO|45|581~REF|6R|11022022742Z6~AMT|B6|119~CLP|1150-251202160738|1|6300|1471.39||HM|183290022|32|2~NM1|QC|1|CLENDENIN|TANISHA||||MI|32353466~NM1|74|1|||M~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|32353466~REF|G1|1720281691~DTM|232|20251101~DTM|233|20251126~DTM|050|20251203~AMT|AU|6300~SVC|HC^G0299|700|155.27|0551~DTM|472|20251101~CAS|CO|45|544.73~REF|6R|11022353005Z1~AMT|B6|155.27~SVC|HC^G0152|700|171.51|0431~DTM|472|20251110~CAS|CO|45|528.49~REF|6R|11022353005Z2~AMT|B6|171.51~SVC|HC^G0151|700|167.89|0421~DTM|472|20251111~CAS|CO|45|532.11~REF|6R|11022353005Z3~AMT|B6|167.89~SVC|HC^G0299|700|155.27|0551~DTM|472|20251111~CAS|CO|45|544.73~REF|6R|11022353005Z4~AMT|B6|155.27~SVC|HC^G0152|700|171.51|0431~DTM|472|20251113~CAS|CO|45|528.49~REF|6R|11022353005Z5~AMT|B6|171.51~SVC|HC^G0299|700|155.27|0551~DTM|472|20251114~CAS|CO|45|544.73~REF|6R|11022353005Z6~AMT|B6|155.27~SVC|HC^G0157|700|167.89|0421~DTM|472|20251118~CAS|CO|45|532.11~REF|6R|11022353005Z7~AMT|B6|167.89~SVC|HC^G0299|700|155.27|0551~DTM|472|20251126~CAS|CO|45|544.73~REF|6R|11022353005Z8~AMT|B6|155.27~SVC|HC^G0152|700|171.51|0431~DTM|472|20251126~CAS|CO|45|528.49~REF|6R|11022353005Z9~AMT|B6|171.51~CLP|1150-251202155522|1|6300|1071||HM|183288985|32|3~NM1|QC|1|WYNDER|ROBERT||||MI|99144378~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|99144378~REF|G1|1720109616~DTM|232|20251029~DTM|233|20251117~DTM|050|20251203~AMT|AU|6300~SVC|HC^G0299|700|119|0551~DTM|472|20251029~CAS|CO|45|581~REF|6R|11022307538Z1~AMT|B6|119~SVC|HC^G0299|700|119|0551~DTM|472|20251031~CAS|CO|45|581~REF|6R|11022307538Z2~AMT|B6|119~SVC|HC^G0299|700|119|0551~DTM|472|20251103~CAS|CO|45|581~REF|6R|11022307538Z3~AMT|B6|119~SVC|HC^G0299|700|119|0551~DTM|472|20251105~CAS|CO|45|581~REF|6R|11022307538Z4~AMT|B6|119~SVC|HC^G0299|700|119|0551~DTM|472|20251107~CAS|CO|45|581~REF|6R|11022307538Z5~AMT|B6|119~SVC|HC^G0299|700|119|0551~DTM|472|20251110~CAS|CO|45|581~REF|6R|11022307538Z6~AMT|B6|119~SVC|HC^G0299|700|119|0551~DTM|472|20251112~CAS|CO|45|581~REF|6R|11022307538Z7~AMT|B6|119~SVC|HC^G0299|700|119|0551~DTM|472|20251114~CAS|CO|45|581~REF|6R|11022307538Z8~AMT|B6|119~SVC|HC^G0299|700|119|0551~DTM|472|20251117~CAS|CO|45|581~REF|6R|11022307538Z9~AMT|B6|119~CLP|1150-251202153959|1|9800|1846||HM|183288980|32|2~NM1|QC|1|WILLIS|HELEN||||MI|83148948~NM1|74|1|||M~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|83148948~REF|G1|1720271234~DTM|232|20251029~DTM|233|20251126~DTM|050|20251203~AMT|AU|9800~SVC|HC^G0299|700|119|0551~DTM|472|20251029~CAS|CO|45|581~REF|6R|11022221439Z1~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20251030~CAS|CO|45|561~REF|6R|11022221439Z2~AMT|B6|139~SVC|HC^G0152|700|139|0431~DTM|472|20251031~CAS|CO|45|561~REF|6R|11022221439Z3~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20251031~CAS|CO|45|581~REF|6R|11022221439Z4~AMT|B6|119~SVC|HC^G0151|700|139|0421~DTM|472|20251104~CAS|CO|45|561~REF|6R|11022221439Z5~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20251107~CAS|CO|45|581~REF|6R|11022221439Z6~AMT|B6|119~SVC|HC^G0152|700|139|0431~DTM|472|20251107~CAS|CO|45|561~REF|6R|11022221439Z7~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20251110~CAS|CO|45|561~REF|6R|11022221439Z8~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20251113~CAS|CO|45|581~REF|6R|11022221439Z9~AMT|B6|119~SVC|HC^G0152|700|139|0431~DTM|472|20251114~CAS|CO|45|561~REF|6R|11022221439Z10~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20251117~CAS|CO|45|561~REF|6R|11022221439Z11~AMT|B6|139~SVC|HC^G0152|700|139|0431~DTM|472|20251120~CAS|CO|45|561~REF|6R|11022221439Z12~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20251124~CAS|CO|45|561~REF|6R|11022221439Z13~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20251126~CAS|CO|45|581~REF|6R|11022221439Z14~AMT|B6|119~CLP|1150-251022135623|22|-4200|-834||HM|182088539|32|2~NM1|QC|1|WALKER|SUSAN||||MI|77223479~NM1|74|1|||S~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|F8|176774221~REF|EA|77223479~DTM|232|20250926~DTM|233|20251015~DTM|050|20251124~SVC|HC^G0151|-700|-139|0421|0~DTM|472|20250926~CAS|CO|45|-561~REF|6R|10790576438Z1~AMT|B6|-139~SVC|HC^G0157|-700|-139|0421|0~DTM|472|20251001~CAS|CO|45|-561~REF|6R|10790576438Z2~AMT|B6|-139~SVC|HC^G0157|-700|-139|0421|0~DTM|472|20251002~CAS|CO|45|-561~REF|6R|10790576438Z3~AMT|B6|-139~SVC|HC^G0157|-700|-139|0421|0~DTM|472|20251009~CAS|CO|45|-561~REF|6R|10790576438Z4~AMT|B6|-139~SVC|HC^G0152|-700|-139|0431|0~DTM|472|20251010~CAS|CO|45|-561~REF|6R|10790576438Z5~AMT|B6|-139~SVC|HC^G0157|-700|-139|0421|0~DTM|472|20251015~CAS|CO|45|-561~REF|6R|10790576438Z6~AMT|B6|-139~CLP|1150-251022135623|1|700|139||HM|182088544|32|7~NM1|QC|1|WALKER|SUSAN||||MI|77223479~NM1|74|1|||S~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|F8|176774221~REF|EA|77223479~REF|G1|1720182203~DTM|232|20250926~DTM|233|20250926~DTM|050|20251124~AMT|AU|700~SVC|HC^G0151|700|139|0421~DTM|472|20250926~CAS|CO|45|561~REF|6R|10970337104Z1~AMT|B6|139~SE|371|0001~GE|1|3474~IEA|1|000003474~