ISA|00| |00| |ZZ|ZIRMED |ZZ|923001C9807506 |260129|2342|}|00501|000003505|0|P|^~GS|HP|ZIRMED|923001C9807506|20260129|2342|3505|X|005010X221A1~ST|835|0001~BPR|I|5949.12|C|ACH|CCP|01|031100209|DA|38876542|1520954463||01|055002338|DA|93128821|20260129~TRN|1|000001850813065|1520954463~DTM|405|20260129~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|1150-260120150915|1|5600.01|1823.61||MA|186197702|32|9~NM1|QC|1|BENSON|DOROTHY||||MI|33293720~NM1|74|1|||L~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|33293720~REF|G1|1720418015~DTM|232|20251213~DTM|233|20260107~DTM|050|20260121~AMT|AU|5600.01~SVC|HC^1JA21|0|1823.61|0023~DTM|472|20251213~CAS|CO|45|-1860.83||253|37.22~REF|6R|11280586387Z1~AMT|B6|1860.83~LQ|HE|N669~SVC|HC^Q5001|.01|0|0551|0||1~DTM|472|20251213~CAS|CO|45|.01~REF|6R|11280586387Z2~SVC|HC^G0299|700|0|0551|0||1~DTM|472|20251213~CAS|CO|45|700~REF|6R|11280586387Z3~SVC|HC^G0151|700|0|0421|0||1~DTM|472|20251215~CAS|CO|45|700~REF|6R|11280586387Z4~SVC|HC^G0152|700|0|0431|0||1~DTM|472|20251215~CAS|CO|45|700~REF|6R|11280586387Z5~SVC|HC^G0151|700|0|0421|0||1~DTM|472|20251217~CAS|CO|45|700~REF|6R|11280586387Z6~SVC|HC^G0299|700|0|0551|0||1~DTM|472|20251219~CAS|CO|45|700~REF|6R|11280586387Z7~SVC|HC^G0151|700|0|0421|0||1~DTM|472|20251222~CAS|CO|45|700~REF|6R|11280586387Z8~SVC|HC^G0152|700|0|0431|0||1~DTM|472|20260107~CAS|CO|45|700~REF|6R|11280586387Z9~SVC|HC^G0151|700|0|0421|0||1~DTM|472|20260107~CAS|CO|45|700~REF|6R|11280586387Z10~CLP|1150-260120143414|1|5600.01|1809.57||MA|186197697|32|9~NM1|QC|1|LOGAN|JAMES||||MI|12310790~NM1|74|1|LOGAN III||T~NM1|82|2|HOMECENTRIS HOME HEALTH II LLC|||||XX|1487113239~REF|EA|12310790~REF|G1|1720397331~DTM|232|20251220~DTM|233|20260106~DTM|050|20260121~AMT|AU|5600.01~SVC|HC^1EA11|0|1809.57|0023~DTM|472|20251220~CAS|CO|45|-1846.5||253|36.93~REF|6R|11280446604Z1~AMT|B6|1846.5~LQ|HE|N669~SVC|HC^Q5001|.01|0|0551|0||1~DTM|472|20251220~CAS|CO|45|.01~REF|6R|11280446604Z2~SVC|HC^G0299|700|0|0551|0||1~DTM|472|20251220~CAS|CO|45|700~REF|6R|11280446604Z3~SVC|HC^G0151|700|0|0421|0||1~DTM|472|20251222~CAS|CO|45|700~REF|6R|11280446604Z4~SVC|HC^G0151|700|0|0421|0||1~DTM|472|20251224~CAS|CO|45|700~REF|6R|11280446604Z5~SVC|HC^G0299|700|0|0551|0||1~DTM|472|20251225~CAS|CO|45|700~REF|6R|11280446604Z6~SVC|HC^G0151|700|0|0421|0||1~DTM|472|20251229~CAS|CO|45|700~REF|6R|11280446604Z7~SVC|HC^G0151|700|0|0421|0||1~DTM|472|20251231~CAS|CO|45|700~REF|6R|11280446604Z8~SVC|HC^G0151|700|0|0421|0||1~DTM|472|20260105~CAS|CO|45|700~REF|6R|11280446604Z9~SVC|HC^G0151|700|0|0421|0||1~DTM|472|20260106~CAS|CO|45|700~REF|6R|11280446604Z10~CLP|1150-260120143924|1|4900.01|2315.94||MA|186197698|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|20251220~DTM|233|20260113~DTM|050|20260121~AMT|AU|4900.01~SVC|HC^3CA31|0|2315.94|0023~DTM|472|20251220~CAS|CO|45|-2363.2||253|47.26~REF|6R|11280462433Z1~AMT|B6|2363.2~LQ|HE|N669~SVC|HC^Q5001|.01|0|0551|0||1~DTM|472|20251220~CAS|CO|45|.01~REF|6R|11280462433Z2~SVC|HC^G0299|700|0|0551|0||1~DTM|472|20251220~CAS|CO|45|700~REF|6R|11280462433Z3~SVC|HC^G0299|700|0|0551|0||1~DTM|472|20251227~CAS|CO|45|700~REF|6R|11280462433Z4~SVC|HC^G0299|700|0|0551|0||1~DTM|472|20251230~CAS|CO|45|700~REF|6R|11280462433Z5~SVC|HC^G0299|700|0|0551|0||1~DTM|472|20260103~CAS|CO|45|700~REF|6R|11280462433Z6~SVC|HC^G0299|700|0|0551|0||1~DTM|472|20260106~CAS|CO|45|700~REF|6R|11280462433Z7~SVC|HC^G0299|700|0|0551|0||1~DTM|472|20260108~CAS|CO|45|700~REF|6R|11280462433Z8~SVC|HC^G0299|700|0|0551|0||1~DTM|472|20260113~CAS|CO|45|700~REF|6R|11280462433Z9~SE|166|0001~GE|1|3505~IEA|1|000003505~