ISA|00| |00| |ZZ|ZIRMED |ZZ|923001C9807506 |260114|2150|}|00501|000003492|0|P|^~GS|HP|ZIRMED|923001C9807506|20260114|2150|3492|X|005010X221A1~ST|835|0001~BPR|I|1245.56|C|ACH|CCP|01|031100209|DA|38876542|1520954463||01|055002338|DA|93128821|20260114~TRN|1|000001850808379|1520954463~DTM|405|20260114~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|1150-251110125251|22|-4200.01|0||15|185567673|32|9~NM1|QC|1|EVERLY|LANA||||MI|28183572~NM1|74|1|||M|||C|000000001~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~MIA|0||||N30~REF|F8|178000266~REF|EA|28183572~DTM|232|20251006~DTM|233|20251030~DTM|050|20251111~SVC|HC^3EA11|0|0|0023|0~DTM|472|20251006~REF|6R|10897286256Z1~SVC|HC^Q5001|-.01|0|0421|0~DTM|472|20251006~CAS|PR|31|-.01~REF|6R|10897286256Z2~LQ|HE|N30~SVC|HC^G0151|-700|0|0421|0~DTM|472|20251006~CAS|PR|31|-700~REF|6R|10897286256Z3~LQ|HE|N30~SVC|HC^G0299|-700|0|0551|0~DTM|472|20251008~CAS|PR|31|-700~REF|6R|10897286256Z4~LQ|HE|N30~SVC|HC^G0157|-700|0|0421|0~DTM|472|20251017~CAS|PR|31|-700~REF|6R|10897286256Z5~LQ|HE|N30~SVC|HC^G0157|-700|0|0421|0~DTM|472|20251020~CAS|PR|31|-700~REF|6R|10897286256Z6~LQ|HE|N30~SVC|HC^G0157|-700|0|0421|0~DTM|472|20251023~CAS|PR|31|-700~REF|6R|10897286256Z7~LQ|HE|N30~SVC|HC^G0151|-700|0|0421|0~DTM|472|20251030~CAS|PR|31|-700~REF|6R|10897286256Z8~LQ|HE|N30~CLP|1150-251110125251|1|4200.01|1245.56||MA|185567674|32|9~NM1|QC|1|EVERLY|LANA||||MI|28183572~NM1|74|1|||M~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|F8|178000266~REF|EA|28183572~REF|G1|1720117824~DTM|232|20251006~DTM|233|20251030~DTM|050|20251111~AMT|AU|4200.01~SVC|HC^3EA11|0|1245.56|0023~DTM|472|20251006~CAS|CO|45|-1270.98||253|25.42~REF|6R|10897286256Z1~AMT|B6|1270.98~LQ|HE|N669~SVC|HC^Q5001|.01|0|0421|0~DTM|472|20251006~CAS|CO|45|.01~REF|6R|10897286256Z2~SVC|HC^G0151|700|0|0421|0~DTM|472|20251006~CAS|CO|45|700~REF|6R|10897286256Z3~SVC|HC^G0299|700|0|0551|0~DTM|472|20251008~CAS|CO|45|700~REF|6R|10897286256Z4~SVC|HC^G0157|700|0|0421|0~DTM|472|20251017~CAS|CO|45|700~REF|6R|10897286256Z5~SVC|HC^G0157|700|0|0421|0~DTM|472|20251020~CAS|CO|45|700~REF|6R|10897286256Z6~SVC|HC^G0157|700|0|0421|0~DTM|472|20251023~CAS|CO|45|700~REF|6R|10897286256Z7~SVC|HC^G0151|700|0|0421|0~DTM|472|20251030~CAS|CO|45|700~REF|6R|10897286256Z8~SE|108|0001~GE|1|3492~IEA|1|000003492~