ISA*00*          *00*          *ZZ*00             *ZZ*               *260923*1309*U*00501*923130935*0*P*>~
GS*HC*52095*52095*20260923*1309*0935*X*005010X223A2~
ST*837*130935*005010X223A2~
BHT*0019*00*000004*20260923*1309*CH~
NM1*41*2*HOMECENTRIS HEALTHCARE LLC*****46*833992125~
PER*IC*MATT AUMAN*TE*4103218448~
NM1*40*2*KAISER MEDICAID*****46*10403~
HL*1**20*1~
PRV*BI*PXC*251E00000X~
NM1*85*2*HOMECENTRIS HEALTHCARE LLC*****XX*1487113239~
N3*10 CROSSROADS DRIVE, SUITE 102~
N4*OWINGS MILLS*MD*211178284~
REF*EI*833992125~
PER*IC*MATT AUMAN*TE*4103218448~
HL*2*1*22*0~
SBR*P*18*******CI~
NM1*IL*1*GALLAGHER*PATRICK****MI*87206026~
N3*12200 BELAIR RD APT 2~
N4*KINGSVILLE*MD*21087~
DMG*D8*19640708*M~
NM1*PR*2*KAISER MEDICAID*****PI*10403~
N3*10 CROSSROADS DRIVE SUITE 102~
N4*OWINGS MILLS*MD*211179999~
CLM*1150-260923130935*2100***32>A>2**A*Y*Y*********~
DTP*434*RD8*20260910-20260918~
DTP*435*DT*202609100001~
CL1*9*2*30~
REF*G1*1721234260-1,1721234261-1~
HI*ABK>S02831D~
HI*ABF>S0232XD*ABF>S0219XD*ABF>S0240FD*ABF>S020XXD*ABF>S0181XD*ABF>S2241XD*ABF>S72102D*ABF>M75101*ABF>M5416*ABF>G894*ABF>I959*ABF>J449*ABF>K7460*ABF>I87303*ABF>D509*ABF>Z9181~
HI*BH>50>D8>20260910~
NM1*71*1*EMMANUEL-ALLEN*LAURA****XX*1114312352~
LX*1~
SV2*0421*HC>G0151*700.00*UN*1~
DTP*472*D8*20260910~
LX*2~
SV2*0431*HC>G0152*700.00*UN*1~
DTP*472*D8*20260911~
LX*3~
SV2*0421*HC>G0151*700.00*UN*1~
DTP*472*D8*20260918~
SE*40*130935~
GE*1*0935~
IEA*1*923130935~