ISA|00| |00| |ZZ|ZIRMED |ZZ|947971C9807506 |260126|2220|}|00501|000003501|0|P|^~GS|HP|ZIRMED|947971C9807506|20260126|2220|3501|X|005010X221A1~ST|835|0001~BPR|I|2967.03|C|ACH|CCP|01|031100209|DA|38876542|1520954463||01|055002338|DA|93128821|20260126~TRN|1|000001850811435|1520954463~DTM|405|20260126~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|1150-260116123631|1|5600|908||HM|186118317|32|3~NM1|QC|1|LEVITT|JASON||||MI|69116927~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|69116927~REF|G1|1720276783~DTM|232|20251229~DTM|233|20260109~DTM|050|20260119~AMT|AU|5600~SVC|HC^G0152|700|139|0431~DTM|472|20251229~CAS|CO|45|561~REF|6R|11263921864Z1~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20251229~CAS|CO|45|561~REF|6R|11263921864Z2~AMT|B6|139~SVC|HC^G0299|700|119|0551~DTM|472|20251231~CAS|CO|45|581~REF|6R|11263921864Z3~AMT|B6|119~SVC|HC^G0156|700|47|0571~DTM|472|20260102~CAS|CO|45|653~REF|6R|11263921864Z4~AMT|B6|47~SVC|HC^G0152|700|139|0431~DTM|472|20260107~CAS|CO|45|561~REF|6R|11263921864Z5~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20260107~CAS|CO|45|561~REF|6R|11263921864Z6~AMT|B6|139~SVC|HC^G0156|700|47|0571~DTM|472|20260108~CAS|CO|45|653~REF|6R|11263921864Z7~AMT|B6|47~SVC|HC^G0151|700|139|0421~DTM|472|20260109~CAS|CO|45|561~REF|6R|11263921864Z8~AMT|B6|139~CLP|1150-260114130825|1|2800|556||HM|185891222|32|1~NM1|QC|1|SOROKINA|NINA||||MI|86234195~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|86234195~REF|G1|1720409782~DTM|232|20251212~DTM|233|20260109~DTM|050|20260115~AMT|AU|2800~SVC|HC^G0151|700|139|0421~DTM|472|20251212~CAS|CO|45|561~REF|6R|11249833868Z1~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20251219~CAS|CO|45|561~REF|6R|11249833868Z2~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20251226~CAS|CO|45|561~REF|6R|11249833868Z3~AMT|B6|139~SVC|HC^G0151|700|139|0421~DTM|472|20260109~CAS|CO|45|561~REF|6R|11249833868Z4~AMT|B6|139~CLP|1150-260113160400|1|2100.01|1335.14||MA|185772269|32|9~NM1|QC|1|DECKERT|EDWARD||||MI|68249357~NM1|74|1|||C~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|68249357~REF|G1|1720260702~DTM|232|20251215~DTM|233|20260108~DTM|050|20260114~AMT|AU|2100.01~SVC|HC^3EB11|0|1335.14|0023~DTM|472|20251215~CAS|CO|45|-1362.39||253|27.25~REF|6R|11243100859Z1~AMT|B6|1362.39~LQ|HE|N669~SVC|HC^Q5001|.01|0|0421|0||1~DTM|472|20251215~CAS|CO|45|.01~REF|6R|11243100859Z2~SVC|HC^G0157|700|0|0421|0||1~DTM|472|20251215~CAS|CO|45|700~REF|6R|11243100859Z3~SVC|HC^G0157|700|0|0421|0||1~DTM|472|20251217~CAS|CO|45|700~REF|6R|11243100859Z4~SVC|HC^G0151|700|0|0421|0||1~DTM|472|20260108~CAS|CO|45|700~REF|6R|11243100859Z5~CLP|1150-260114120521|22|-2100|-335.78||HM|186147328|32|1~NM1|QC|1|HENDERSON|MOLLY||||MI|28356037~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|F8|185891772~REF|EA|28356037~DTM|232|20251230~DTM|233|20260106~DTM|050|20260120~SVC|HC^G0151|-700|-167.89|0421|0~DTM|472|20251230~CAS|CO|45|-532.11~REF|6R|11249480130Z1~AMT|B6|-167.89~SVC|HC^G0151|-700|-167.89|0421|0~DTM|472|20260106~CAS|CO|45|-532.11~REF|6R|11249480130Z2~AMT|B6|-167.89~SVC|HC^G0151|-700|0|0421|0~DTM|472|20251230~CAS|CO|45|-700~REF|6R|11249480130Z3~CLP|1150-260114120521|1|2100|503.67||HM|186147332|32|7~NM1|QC|1|HENDERSON|MOLLY||||MI|28356037~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|F8|185891772~REF|EA|28356037~REF|G1|1720449491~DTM|232|20251230~DTM|233|20260108~DTM|050|20260120~AMT|AU|2100~SVC|HC^G0151|700|167.89|0421~DTM|472|20251230~CAS|CO|45|532.11~REF|6R|11273598403Z1~AMT|B6|167.89~SVC|HC^G0151|700|167.89|0421~DTM|472|20260106~CAS|CO|45|532.11~REF|6R|11273598403Z2~AMT|B6|167.89~SVC|HC^G0151|700|167.89|0421~DTM|472|20260108~CAS|CO|45|532.11~REF|6R|11273598403Z3~AMT|B6|167.89~SE|172|0001~GE|1|3501~IEA|1|000003501~