Remittances / GP99900000631

Granite Plains Mutual

Payment GP99900000631, electronic funds transfer dated Sep 28, 2026. From GPM_ERA_B.835, imported Sep 29, 2026 by Dana Whitfield.

Balances to the cent

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Payments dated Sep 28, 2026 to Sep 28, 2026, as of Oct 6, 2026. Whole organization, every site.

Payment

$22,241.16

Electronic funds transfer

Claims

66 matched to billed claims

Claim payments

$22,241.16

Before provider adjustments

Provider adjustments

$0.00

Interest added, recoveries taken

Claims in this payment

Matched to what was billed and checked against the contract rate.

Claim	Match	Result	Charged	Allowed	Paid	Patient	At stake
RHP1OO151	Suggested match on payer, service date and charge to RHP100151	Paid as expected	$312.00	$153.40	$128.40 patient $25.00	$25.00
LEGACY-55120	No billed claim found	Unmatched	$221.00	$108.56	$108.56	$0.00	$108.56
RHP100153	Claim number matched exactly	Paid as expected	$240.00	$118.00	$106.20 patient $11.80	$11.80
RHP100154	Claim number matched exactly	Underpaid	$449.00	$207.42	$207.42	$0.00	$13.24
RHP100155	Claim number matched exactly	Denied	$312.00	$0.00	$0.00	$0.00	$153.40
RHP100156	Claim number matched exactly	Paid as expected	$156.00	$76.70	$76.70	$0.00
RHP100232	Claim number matched exactly	Paid as expected	$624.00	$306.80	$306.80	$0.00
RHP100800	Claim number matched exactly	Paid as expected	$228.00	$112.10	$87.10 patient $25.00	$25.00
RHP100801	Claim number matched exactly	Underpaid	$1,728.00	$773.14	$773.14	$0.00	$76.46
RHP100802	Claim number matched exactly	Paid as expected	$319.00	$156.94	$125.55 patient $31.39	$31.39
RHP100803	Claim number matched exactly	Paid as expected	$624.00	$306.80	$156.80 patient $150.00	$150.00
RHP100804	Claim number matched exactly	Paid as expected	$240.00	$118.00	$118.00	$0.00
RHP100805	Claim number matched exactly	Underpaid	$3,480.00	$1,557.01	$1,557.01	$0.00	$153.99
RHP100806	Claim number matched exactly	Paid as expected	$439.00	$215.94	$194.35 patient $21.59	$21.59
RHP100807	Claim number matched exactly	Paid as expected	$912.00	$448.40	$448.40	$0.00
RHP100808	Claim number matched exactly	Paid as expected	$269.00	$132.16	$92.16 patient $40.00	$40.00
RHP100809	Claim number matched exactly	Denied	$528.00	$0.00	$0.00	$0.00	$259.60
RHP100810	Claim number matched exactly	Paid as expected	$449.00	$220.66	$220.66	$0.00
RHP100811	Claim number matched exactly	Underpaid	$2,520.00	$1,127.49	$1,127.49	$0.00	$111.51
RHP100812	Claim number matched exactly	Paid as expected	$140.00	$68.44	$54.75 patient $13.69	$13.69
RHP100813	Claim number matched exactly	Paid as expected	$576.00	$283.20	$233.20 patient $50.00	$50.00
RHP100814	Claim number matched exactly	Paid as expected	$310.00	$152.22	$152.22	$0.00
RHP100815	Claim number matched exactly	Paid as expected	$338.00	$166.38	$66.38 patient $100.00	$100.00
RHP100816	Claim number matched exactly	Paid as expected	$228.00	$112.10	$87.10 patient $25.00	$25.00
RHP100817	Claim number matched exactly	Underpaid	$1,728.00	$773.14	$773.14	$0.00	$76.46
RHP100818	Claim number matched exactly	Paid as expected	$319.00	$156.94	$125.55 patient $31.39	$31.39
RHP100819	Claim number matched exactly	Paid as expected	$624.00	$306.80	$156.80 patient $150.00	$150.00
RHP100820	Claim number matched exactly	Paid as expected	$240.00	$118.00	$118.00	$0.00
RHP100821	Claim number matched exactly	Underpaid	$3,480.00	$1,557.01	$1,557.01	$0.00	$153.99
RHP100822	Claim number matched exactly	Denied	$439.00	$0.00	$0.00	$0.00	$215.94
RHP100823	Claim number matched exactly	Paid as expected	$912.00	$448.40	$448.40	$0.00
RHP100824	Claim number matched exactly	Paid as expected	$269.00	$132.16	$92.16 patient $40.00	$40.00
RHP100825	Claim number matched exactly	Paid as expected	$528.00	$259.60	$207.68 patient $51.92	$51.92
RHP100826	Claim number matched exactly	Paid as expected	$449.00	$220.66	$220.66	$0.00
RHP100827	Claim number matched exactly	Underpaid	$2,520.00	$1,127.49	$1,127.49	$0.00	$111.51
RHP100828	Claim number matched exactly	Paid as expected	$140.00	$68.44	$54.75 patient $13.69	$13.69
RHP100829	Claim number matched exactly	Paid as expected	$576.00	$283.20	$233.20 patient $50.00	$50.00
RHP100830	Claim number matched exactly	Paid as expected	$310.00	$152.22	$152.22	$0.00
RHP100831	Claim number matched exactly	Paid as expected	$338.00	$166.38	$66.38 patient $100.00	$100.00
RHP100832	Claim number matched exactly	Paid as expected	$228.00	$112.10	$87.10 patient $25.00	$25.00
RHP100833	Claim number matched exactly	Underpaid	$1,728.00	$773.14	$773.14	$0.00	$76.46
RHP100834	Claim number matched exactly	Paid as expected	$319.00	$156.94	$125.55 patient $31.39	$31.39
RHP100835	Claim number matched exactly	Denied	$624.00	$0.00	$0.00	$0.00	$306.80
RHP100836	Claim number matched exactly	Paid as expected	$240.00	$118.00	$118.00	$0.00
RHP100837	Claim number matched exactly	Underpaid	$3,480.00	$1,557.01	$1,557.01	$0.00	$153.99
RHP100838	Claim number matched exactly	Paid as expected	$439.00	$215.94	$194.35 patient $21.59	$21.59
RHP100839	Claim number matched exactly	Paid as expected	$912.00	$448.40	$448.40	$0.00
RHP100840	Claim number matched exactly	Paid as expected	$269.00	$132.16	$92.16 patient $40.00	$40.00
RHP100841	Claim number matched exactly	Paid as expected	$528.00	$259.60	$207.68 patient $51.92	$51.92
RHP100842	Claim number matched exactly	Paid as expected	$449.00	$220.66	$220.66	$0.00
RHP100843	Claim number matched exactly	Underpaid	$2,520.00	$1,127.49	$1,127.49	$0.00	$111.51
RHP100844	Claim number matched exactly	Paid as expected	$140.00	$68.44	$54.75 patient $13.69	$13.69
RHP100845	Claim number matched exactly	Paid as expected	$576.00	$283.20	$233.20 patient $50.00	$50.00
RHP100846	Claim number matched exactly	Paid as expected	$310.00	$152.22	$152.22	$0.00
RHP100847	Claim number matched exactly	Paid as expected	$338.00	$166.38	$66.38 patient $100.00	$100.00
RHP100848	Claim number matched exactly	Denied	$228.00	$0.00	$0.00	$0.00	$112.10
RHP100849	Claim number matched exactly	Underpaid	$1,728.00	$773.14	$773.14	$0.00	$76.46
RHP100850	Claim number matched exactly	Paid as expected	$319.00	$156.94	$125.55 patient $31.39	$31.39
RHP100851	Claim number matched exactly	Paid as expected	$624.00	$306.80	$156.80 patient $150.00	$150.00
RHP100852	Claim number matched exactly	Paid as expected	$240.00	$118.00	$118.00	$0.00
RHP100853	Claim number matched exactly	Underpaid	$3,480.00	$1,557.01	$1,557.01	$0.00	$153.99
RHP100854	Claim number matched exactly	Paid as expected	$439.00	$215.94	$194.35 patient $21.59	$21.59
RHP100855	Claim number matched exactly	Paid as expected	$912.00	$448.40	$448.40	$0.00
RHP100856	Claim number matched exactly	Paid as expected	$269.00	$132.16	$92.16 patient $40.00	$40.00
RHP100857	Claim number matched exactly	Paid as expected	$528.00	$259.60	$207.68 patient $51.92	$51.92
RHP100858	Claim number matched exactly	Paid as expected	$449.00	$220.66	$220.66	$0.00
RHP100859	Claim number matched exactly	Underpaid	$2,520.00	$1,127.49	$1,127.49	$0.00	$111.51

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The payer's remittance file (835)

Payer ID 99902. Payee RIDGELINE HEALTH PARTNERS, NPI 9999999001. Transaction 0001, 851 segments.

Show the raw file (855 segments)

1  ISA*00*          *00*          *ZZ*PAYER99902     *ZZ*RIDGELINE999   *260927*0800*^*00501*000000108*0*T*:
2  GS*HP*PAYER99902*RIDGELINE999*20260927*0800*108*X*005010X221A1
3  ST*835*0001
4  BPR*I*22241.16*C*ACH*CCP*01*999999992*DA*000111222*1999999999**01*999999993*DA*000333444*20260928
5  TRN*1*GP99900000631*1999999902
6  DTM*405*20260927
7  N1*PR*GRANITE PLAINS MUTUAL
8  REF*2U*99902
9  N1*PE*RIDGELINE HEALTH PARTNERS*XX*9999999001
10  REF*TJ*999999999
11  LX*1
12  CLP*RHP1OO151*1*312*128.4*25*CI*999020631001*11*1
13  NM1*QC*1*SYNTHETIC*PATIENT100151****MI*ZZ0100151
14  DTM*232*20260906
15  DTM*233*20260906
16  SVC*HC:99214*312*128.4**1
17  DTM*472*20260906
18  CAS*CO*45*158.6
19  CAS*PR*3*25
20  REF*6R*RHP100151-1
21  AMT*B6*153.4
22  LX*2
23  CLP*LEGACY-55120*1*221*108.56*0*CI*999020631002*11*1
24  NM1*QC*1*SYNTHETIC*PATIENT100152****MI*ZZ0100152
25  DTM*232*20260907
26  DTM*233*20260907
27  SVC*HC:99213*221*108.56**1
28  DTM*472*20260907
29  CAS*CO*45*112.44
30  REF*6R*RHP100152-1
31  AMT*B6*108.56
32  LX*3
33  CLP*RHP100153*1*240*106.2*11.8*CI*999020631003*11*1
34  NM1*QC*1*SYNTHETIC*PATIENT100153****MI*ZZ0100153
35  DTM*232*20260908
36  DTM*233*20260908
37  SVC*HC:99213*221*97.7**1
38  DTM*472*20260908
39  CAS*CO*45*112.44
40  CAS*PR*2*10.86
41  REF*6R*RHP100153-1
42  AMT*B6*108.56
43  SVC*HC:85025*19*8.5**1
44  DTM*472*20260908
45  CAS*CO*45*9.56
46  CAS*PR*2*0.94
47  REF*6R*RHP100153-2
48  AMT*B6*9.44
49  LX*4
50  CLP*RHP100154*1*449*207.42*0*CI*999020631004*11*1
51  NM1*QC*1*SYNTHETIC*PATIENT100154****MI*ZZ0100154
52  DTM*232*20260909
53  DTM*233*20260909
54  SVC*HC:99204*408*188.56**1
55  DTM*472*20260909
56  CAS*CO*45*219.44
57  REF*6R*RHP100154-1
58  AMT*B6*188.56
59  SVC*HC:93000*41*18.86**1
60  DTM*472*20260909
61  CAS*CO*45*22.14
62  REF*6R*RHP100154-2
63  AMT*B6*18.86
64  LX*5
65  CLP*RHP100155*4*312*0*0*CI*999020631005*11*1
66  NM1*QC*1*SYNTHETIC*PATIENT100155****MI*ZZ0100155
67  DTM*232*20260910
68  DTM*233*20260910
69  SVC*HC:99214*312*0**1
70  DTM*472*20260910
71  CAS*CO*18*312
72  REF*6R*RHP100155-1
73  AMT*B6*0
74  LX*6
75  CLP*RHP100156*1*156*76.7*0*CI*999020631006*11*1
76  NM1*QC*1*SYNTHETIC*PATIENT100156****MI*ZZ0100156
77  DTM*232*20260911
78  DTM*233*20260911
79  SVC*HC:20610*156*76.7**1
80  DTM*472*20260911
81  CAS*CO*45*79.3
82  REF*6R*RHP100156-1
83  AMT*B6*76.7
84  LX*7
85  CLP*RHP100232*1*624*306.8*0*CI*999020631007C*11*1
86  NM1*QC*1*SYNTHETIC*PATIENT100232****MI*ZZ0100232
87  DTM*232*20260805
88  DTM*233*20260805
89  SVC*HC:73721*624*306.8**1
90  DTM*472*20260805
91  CAS*CO*45*317.2
92  REF*6R*RHP100232-1
93  AMT*B6*306.8
94  LX*8
95  CLP*RHP100800*1*228*87.1*25*CI*999020631008*11*1
96  NM1*QC*1*SYNTHETIC*PATIENT100800****MI*ZZ0100800
97  DTM*232*20260916
98  DTM*233*20260916
99  SVC*HC:99213*221*83.56**1
100  DTM*472*20260916
101  CAS*CO*45*112.44
102  CAS*PR*3*25
103  REF*6R*RHP100800-1
104  AMT*B6*108.56
105  SVC*HC:36415*7*3.54**1
106  DTM*472*20260916
107  CAS*CO*45*3.46
108  REF*6R*RHP100800-2
109  AMT*B6*3.54
110  LX*9
111  CLP*RHP100801*1*1728*773.14*0*CI*999020631009*11*1
112  NM1*QC*1*SYNTHETIC*PATIENT100801****MI*ZZ0100801
113  DTM*232*20260915
114  DTM*233*20260915
115  SVC*HC:29881*1728*773.14**1
116  DTM*472*20260915
117  CAS*CO*45*954.86
118  REF*6R*RHP100801-1
119  AMT*B6*773.14
120  LX*10
121  CLP*RHP100802*1*319*125.55*31.39*CI*999020631010*11*1
122  NM1*QC*1*SYNTHETIC*PATIENT100802****MI*ZZ0100802
123  DTM*232*20260914
124  DTM*233*20260914
125  SVC*HC:99214*312*122.72**1
126  DTM*472*20260914
127  CAS*CO*45*158.6
128  CAS*PR*2*30.68
129  REF*6R*RHP100802-1
130  AMT*B6*153.4
131  SVC*HC:36415*7*2.83**1
132  DTM*472*20260914
133  CAS*CO*45*3.46
134  CAS*PR*2*0.71
135  REF*6R*RHP100802-2
136  AMT*B6*3.54
137  LX*11
138  CLP*RHP100803*1*624*156.8*150*CI*999020631011*11*1
139  NM1*QC*1*SYNTHETIC*PATIENT100803****MI*ZZ0100803
140  DTM*232*20260913
141  DTM*233*20260913
142  SVC*HC:73721*624*156.8**1
143  DTM*472*20260913
144  CAS*CO*45*317.2
145  CAS*PR*1*150
146  REF*6R*RHP100803-1
147  AMT*B6*306.8
148  LX*12
149  CLP*RHP100804*1*240*118*0*CI*999020631012*11*1
150  NM1*QC*1*SYNTHETIC*PATIENT100804****MI*ZZ0100804
151  DTM*232*20260912
152  DTM*233*20260912
153  SVC*HC:99213*221*108.56**1
154  DTM*472*20260912
155  CAS*CO*45*112.44
156  REF*6R*RHP100804-1
157  AMT*B6*108.56
158  SVC*HC:85025*19*9.44**1
159  DTM*472*20260912
160  CAS*CO*45*9.56
161  REF*6R*RHP100804-2
162  AMT*B6*9.44
163  LX*13
164  CLP*RHP100805*1*3480*1557.01*0*CI*999020631013*11*1
165  NM1*QC*1*SYNTHETIC*PATIENT100805****MI*ZZ0100805
166  DTM*232*20260911
167  DTM*233*20260911
168  SVC*HC:27447*3480*1557.01**1
169  DTM*472*20260911
170  CAS*CO*45*1922.99
171  REF*6R*RHP100805-1
172  AMT*B6*1557.01
173  LX*14
174  CLP*RHP100806*1*439*194.35*21.59*CI*999020631014*11*1
175  NM1*QC*1*SYNTHETIC*PATIENT100806****MI*ZZ0100806
176  DTM*232*20260910
177  DTM*233*20260910
178  SVC*HC:99215*439*194.35**1
179  DTM*472*20260910
180  CAS*CO*45*223.06
181  CAS*PR*2*21.59
182  REF*6R*RHP100806-1
183  AMT*B6*215.94
184  LX*15
185  CLP*RHP100807*1*912*448.4*0*CI*999020631015*11*1
186  NM1*QC*1*SYNTHETIC*PATIENT100807****MI*ZZ0100807
187  DTM*232*20260909
188  DTM*233*20260909
189  SVC*HC:45380*912*448.4**1
190  DTM*472*20260909
191  CAS*CO*45*463.6
192  REF*6R*RHP100807-1
193  AMT*B6*448.4
194  LX*16
195  CLP*RHP100808*1*269*92.16*40*CI*999020631016*11*1
196  NM1*QC*1*SYNTHETIC*PATIENT100808****MI*ZZ0100808
197  DTM*232*20260908
198  DTM*233*20260908
199  SVC*HC:99203*269*92.16**1
200  DTM*472*20260908
201  CAS*CO*45*136.84
202  CAS*PR*3*40
203  REF*6R*RHP100808-1
204  AMT*B6*132.16
205  LX*17
206  CLP*RHP100809*4*528*0*0*CI*999020631017*11*1
207  NM1*QC*1*SYNTHETIC*PATIENT100809****MI*ZZ0100809
208  DTM*232*20260907
209  DTM*233*20260907
210  SVC*HC:93306*528*0**1
211  DTM*472*20260907
212  CAS*CO*50*528
213  REF*6R*RHP100809-1
214  AMT*B6*0
215  LQ*HE*N130
216  LX*18
217  CLP*RHP100810*1*449*220.66*0*CI*999020631018*11*1
218  NM1*QC*1*SYNTHETIC*PATIENT100810****MI*ZZ0100810
219  DTM*232*20260906
220  DTM*233*20260906
221  SVC*HC:99204*408*200.6**1
222  DTM*472*20260906
223  CAS*CO*45*207.4
224  REF*6R*RHP100810-1
225  AMT*B6*200.6
226  SVC*HC:93000*41*20.06**1
227  DTM*472*20260906
228  CAS*CO*45*20.94
229  REF*6R*RHP100810-2
230  AMT*B6*20.06
231  LX*19
232  CLP*RHP100811*1*2520*1127.49*0*CI*999020631019*11*1
233  NM1*QC*1*SYNTHETIC*PATIENT100811****MI*ZZ0100811
234  DTM*232*20260905
235  DTM*233*20260905
236  SVC*HC:29827*2520*1127.49**1
237  DTM*472*20260905
238  CAS*CO*45*1392.51
239  REF*6R*RHP100811-1
240  AMT*B6*1127.49
241  LX*20
242  CLP*RHP100812*1*140*54.75*13.69*CI*999020631020*11*1
243  NM1*QC*1*SYNTHETIC*PATIENT100812****MI*ZZ0100812
244  DTM*232*20260904
245  DTM*233*20260904
246  SVC*HC:97110*140*54.75**2
247  DTM*472*20260904
248  CAS*CO*45*71.56
249  CAS*PR*2*13.69
250  REF*6R*RHP100812-1
251  AMT*B6*68.44
252  LX*21
253  CLP*RHP100813*1*576*233.2*50*CI*999020631021*11*1
254  NM1*QC*1*SYNTHETIC*PATIENT100813****MI*ZZ0100813
255  DTM*232*20260903
256  DTM*233*20260903
257  SVC*HC:64483*576*233.2**1
258  DTM*472*20260903
259  CAS*CO*45*292.8
260  CAS*PR*3*50
261  REF*6R*RHP100813-1
262  AMT*B6*283.2
263  LX*22
264  CLP*RHP100814*1*310*152.22*0*CI*999020631022*11*1
265  NM1*QC*1*SYNTHETIC*PATIENT100814****MI*ZZ0100814
266  DTM*232*20260902
267  DTM*233*20260902
268  SVC*HC:99213*221*108.56**1
269  DTM*472*20260902
270  CAS*CO*45*112.44
271  REF*6R*RHP100814-1
272  AMT*B6*108.56
273  SVC*HC:90471*41*20.06**1
274  DTM*472*20260902
275  CAS*CO*45*20.94
276  REF*6R*RHP100814-2
277  AMT*B6*20.06
278  SVC*HC:90686*48*23.6**1
279  DTM*472*20260902
280  CAS*CO*45*24.4
281  REF*6R*RHP100814-3
282  AMT*B6*23.6
283  LX*23
284  CLP*RHP100815*1*338*66.38*100*CI*999020631023*11*1
285  NM1*QC*1*SYNTHETIC*PATIENT100815****MI*ZZ0100815
286  DTM*232*20260901
287  DTM*233*20260901
288  SVC*HC:99214*312*53.4**1
289  DTM*472*20260901
290  CAS*CO*45*158.6
291  CAS*PR*1*100
292  REF*6R*RHP100815-1
293  AMT*B6*153.4
294  SVC*HC:80053*26*12.98**1
295  DTM*472*20260901
296  CAS*CO*45*13.02
297  REF*6R*RHP100815-2
298  AMT*B6*12.98
299  LX*24
300  CLP*RHP100816*1*228*87.1*25*CI*999020631024*11*1
301  NM1*QC*1*SYNTHETIC*PATIENT100816****MI*ZZ0100816
302  DTM*232*20260831
303  DTM*233*20260831
304  SVC*HC:99213*221*83.56**1
305  DTM*472*20260831
306  CAS*CO*45*112.44
307  CAS*PR*3*25
308  REF*6R*RHP100816-1
309  AMT*B6*108.56
310  SVC*HC:36415*7*3.54**1
311  DTM*472*20260831
312  CAS*CO*45*3.46
313  REF*6R*RHP100816-2
314  AMT*B6*3.54
315  LX*25
316  CLP*RHP100817*1*1728*773.14*0*CI*999020631025*11*1
317  NM1*QC*1*SYNTHETIC*PATIENT100817****MI*ZZ0100817
318  DTM*232*20260830
319  DTM*233*20260830
320  SVC*HC:29881*1728*773.14**1
321  DTM*472*20260830
322  CAS*CO*45*954.86
323  REF*6R*RHP100817-1
324  AMT*B6*773.14
325  LX*26
326  CLP*RHP100818*1*319*125.55*31.39*CI*999020631026*11*1
327  NM1*QC*1*SYNTHETIC*PATIENT100818****MI*ZZ0100818
328  DTM*232*20260916
329  DTM*233*20260916
330  SVC*HC:99214*312*122.72**1
331  DTM*472*20260916
332  CAS*CO*45*158.6
333  CAS*PR*2*30.68
334  REF*6R*RHP100818-1
335  AMT*B6*153.4
336  SVC*HC:36415*7*2.83**1
337  DTM*472*20260916
338  CAS*CO*45*3.46
339  CAS*PR*2*0.71
340  REF*6R*RHP100818-2
341  AMT*B6*3.54
342  LX*27
343  CLP*RHP100819*1*624*156.8*150*CI*999020631027*11*1
344  NM1*QC*1*SYNTHETIC*PATIENT100819****MI*ZZ0100819
345  DTM*232*20260915
346  DTM*233*20260915
347  SVC*HC:73721*624*156.8**1
348  DTM*472*20260915
349  CAS*CO*45*317.2
350  CAS*PR*1*150
351  REF*6R*RHP100819-1
352  AMT*B6*306.8
353  LX*28
354  CLP*RHP100820*1*240*118*0*CI*999020631028*11*1
355  NM1*QC*1*SYNTHETIC*PATIENT100820****MI*ZZ0100820
356  DTM*232*20260914
357  DTM*233*20260914
358  SVC*HC:99213*221*108.56**1
359  DTM*472*20260914
360  CAS*CO*45*112.44
361  REF*6R*RHP100820-1
362  AMT*B6*108.56
363  SVC*HC:85025*19*9.44**1
364  DTM*472*20260914
365  CAS*CO*45*9.56
366  REF*6R*RHP100820-2
367  AMT*B6*9.44
368  LX*29
369  CLP*RHP100821*1*3480*1557.01*0*CI*999020631029*11*1
370  NM1*QC*1*SYNTHETIC*PATIENT100821****MI*ZZ0100821
371  DTM*232*20260913
372  DTM*233*20260913
373  SVC*HC:27447*3480*1557.01**1
374  DTM*472*20260913
375  CAS*CO*45*1922.99
376  REF*6R*RHP100821-1
377  AMT*B6*1557.01
378  LX*30
379  CLP*RHP100822*4*439*0*0*CI*999020631030*11*1
380  NM1*QC*1*SYNTHETIC*PATIENT100822****MI*ZZ0100822
381  DTM*232*20260912
382  DTM*233*20260912
383  SVC*HC:99215*439*0**1
384  DTM*472*20260912
385  CAS*CO*22*439
386  REF*6R*RHP100822-1
387  AMT*B6*0
388  LX*31
389  CLP*RHP100823*1*912*448.4*0*CI*999020631031*11*1
390  NM1*QC*1*SYNTHETIC*PATIENT100823****MI*ZZ0100823
391  DTM*232*20260911
392  DTM*233*20260911
393  SVC*HC:45380*912*448.4**1
394  DTM*472*20260911
395  CAS*CO*45*463.6
396  REF*6R*RHP100823-1
397  AMT*B6*448.4
398  LX*32
399  CLP*RHP100824*1*269*92.16*40*CI*999020631032*11*1
400  NM1*QC*1*SYNTHETIC*PATIENT100824****MI*ZZ0100824
401  DTM*232*20260910
402  DTM*233*20260910
403  SVC*HC:99203*269*92.16**1
404  DTM*472*20260910
405  CAS*CO*45*136.84
406  CAS*PR*3*40
407  REF*6R*RHP100824-1
408  AMT*B6*132.16
409  LX*33
410  CLP*RHP100825*1*528*207.68*51.92*CI*999020631033*11*1
411  NM1*QC*1*SYNTHETIC*PATIENT100825****MI*ZZ0100825
412  DTM*232*20260909
413  DTM*233*20260909
414  SVC*HC:93306*528*207.68**1
415  DTM*472*20260909
416  CAS*CO*45*268.4
417  CAS*PR*2*51.92
418  REF*6R*RHP100825-1
419  AMT*B6*259.6
420  LX*34
421  CLP*RHP100826*1*449*220.66*0*CI*999020631034*11*1
422  NM1*QC*1*SYNTHETIC*PATIENT100826****MI*ZZ0100826
423  DTM*232*20260908
424  DTM*233*20260908
425  SVC*HC:99204*408*200.6**1
426  DTM*472*20260908
427  CAS*CO*45*207.4
428  REF*6R*RHP100826-1
429  AMT*B6*200.6
430  SVC*HC:93000*41*20.06**1
431  DTM*472*20260908
432  CAS*CO*45*20.94
433  REF*6R*RHP100826-2
434  AMT*B6*20.06
435  LX*35
436  CLP*RHP100827*1*2520*1127.49*0*CI*999020631035*11*1
437  NM1*QC*1*SYNTHETIC*PATIENT100827****MI*ZZ0100827
438  DTM*232*20260907
439  DTM*233*20260907
440  SVC*HC:29827*2520*1127.49**1
441  DTM*472*20260907
442  CAS*CO*45*1392.51
443  REF*6R*RHP100827-1
444  AMT*B6*1127.49
445  LX*36
446  CLP*RHP100828*1*140*54.75*13.69*CI*999020631036*11*1
447  NM1*QC*1*SYNTHETIC*PATIENT100828****MI*ZZ0100828
448  DTM*232*20260906
449  DTM*233*20260906
450  SVC*HC:97110*140*54.75**2
451  DTM*472*20260906
452  CAS*CO*45*71.56
453  CAS*PR*2*13.69
454  REF*6R*RHP100828-1
455  AMT*B6*68.44
456  LX*37
457  CLP*RHP100829*1*576*233.2*50*CI*999020631037*11*1
458  NM1*QC*1*SYNTHETIC*PATIENT100829****MI*ZZ0100829
459  DTM*232*20260905
460  DTM*233*20260905
461  SVC*HC:64483*576*233.2**1
462  DTM*472*20260905
463  CAS*CO*45*292.8
464  CAS*PR*3*50
465  REF*6R*RHP100829-1
466  AMT*B6*283.2
467  LX*38
468  CLP*RHP100830*1*310*152.22*0*CI*999020631038*11*1
469  NM1*QC*1*SYNTHETIC*PATIENT100830****MI*ZZ0100830
470  DTM*232*20260904
471  DTM*233*20260904
472  SVC*HC:99213*221*108.56**1
473  DTM*472*20260904
474  CAS*CO*45*112.44
475  REF*6R*RHP100830-1
476  AMT*B6*108.56
477  SVC*HC:90471*41*20.06**1
478  DTM*472*20260904
479  CAS*CO*45*20.94
480  REF*6R*RHP100830-2
481  AMT*B6*20.06
482  SVC*HC:90686*48*23.6**1
483  DTM*472*20260904
484  CAS*CO*45*24.4
485  REF*6R*RHP100830-3
486  AMT*B6*23.6
487  LX*39
488  CLP*RHP100831*1*338*66.38*100*CI*999020631039*11*1
489  NM1*QC*1*SYNTHETIC*PATIENT100831****MI*ZZ0100831
490  DTM*232*20260903
491  DTM*233*20260903
492  SVC*HC:99214*312*53.4**1
493  DTM*472*20260903
494  CAS*CO*45*158.6
495  CAS*PR*1*100
496  REF*6R*RHP100831-1
497  AMT*B6*153.4
498  SVC*HC:80053*26*12.98**1
499  DTM*472*20260903
500  CAS*CO*45*13.02
501  REF*6R*RHP100831-2
502  AMT*B6*12.98
503  LX*40
504  CLP*RHP100832*1*228*87.1*25*CI*999020631040*11*1
505  NM1*QC*1*SYNTHETIC*PATIENT100832****MI*ZZ0100832
506  DTM*232*20260902
507  DTM*233*20260902
508  SVC*HC:99213*221*83.56**1
509  DTM*472*20260902
510  CAS*CO*45*112.44
511  CAS*PR*3*25
512  REF*6R*RHP100832-1
513  AMT*B6*108.56
514  SVC*HC:36415*7*3.54**1
515  DTM*472*20260902
516  CAS*CO*45*3.46
517  REF*6R*RHP100832-2
518  AMT*B6*3.54
519  LX*41
520  CLP*RHP100833*1*1728*773.14*0*CI*999020631041*11*1
521  NM1*QC*1*SYNTHETIC*PATIENT100833****MI*ZZ0100833
522  DTM*232*20260901
523  DTM*233*20260901
524  SVC*HC:29881*1728*773.14**1
525  DTM*472*20260901
526  CAS*CO*45*954.86
527  REF*6R*RHP100833-1
528  AMT*B6*773.14
529  LX*42
530  CLP*RHP100834*1*319*125.55*31.39*CI*999020631042*11*1
531  NM1*QC*1*SYNTHETIC*PATIENT100834****MI*ZZ0100834
532  DTM*232*20260831
533  DTM*233*20260831
534  SVC*HC:99214*312*122.72**1
535  DTM*472*20260831
536  CAS*CO*45*158.6
537  CAS*PR*2*30.68
538  REF*6R*RHP100834-1
539  AMT*B6*153.4
540  SVC*HC:36415*7*2.83**1
541  DTM*472*20260831
542  CAS*CO*45*3.46
543  CAS*PR*2*0.71
544  REF*6R*RHP100834-2
545  AMT*B6*3.54
546  LX*43
547  CLP*RHP100835*4*624*0*0*CI*999020631043*11*1
548  NM1*QC*1*SYNTHETIC*PATIENT100835****MI*ZZ0100835
549  DTM*232*20260830
550  DTM*233*20260830
551  SVC*HC:73721*624*0**1
552  DTM*472*20260830
553  CAS*CO*197*624
554  REF*6R*RHP100835-1
555  AMT*B6*0
556  LX*44
557  CLP*RHP100836*1*240*118*0*CI*999020631044*11*1
558  NM1*QC*1*SYNTHETIC*PATIENT100836****MI*ZZ0100836
559  DTM*232*20260916
560  DTM*233*20260916
561  SVC*HC:99213*221*108.56**1
562  DTM*472*20260916
563  CAS*CO*45*112.44
564  REF*6R*RHP100836-1
565  AMT*B6*108.56
566  SVC*HC:85025*19*9.44**1
567  DTM*472*20260916
568  CAS*CO*45*9.56
569  REF*6R*RHP100836-2
570  AMT*B6*9.44
571  LX*45
572  CLP*RHP100837*1*3480*1557.01*0*CI*999020631045*11*1
573  NM1*QC*1*SYNTHETIC*PATIENT100837****MI*ZZ0100837
574  DTM*232*20260915
575  DTM*233*20260915
576  SVC*HC:27447*3480*1557.01**1
577  DTM*472*20260915
578  CAS*CO*45*1922.99
579  REF*6R*RHP100837-1
580  AMT*B6*1557.01
581  LX*46
582  CLP*RHP100838*1*439*194.35*21.59*CI*999020631046*11*1
583  NM1*QC*1*SYNTHETIC*PATIENT100838****MI*ZZ0100838
584  DTM*232*20260914
585  DTM*233*20260914
586  SVC*HC:99215*439*194.35**1
587  DTM*472*20260914
588  CAS*CO*45*223.06
589  CAS*PR*2*21.59
590  REF*6R*RHP100838-1
591  AMT*B6*215.94
592  LX*47
593  CLP*RHP100839*1*912*448.4*0*CI*999020631047*11*1
594  NM1*QC*1*SYNTHETIC*PATIENT100839****MI*ZZ0100839
595  DTM*232*20260913
596  DTM*233*20260913
597  SVC*HC:45380*912*448.4**1
598  DTM*472*20260913
599  CAS*CO*45*463.6
600  REF*6R*RHP100839-1
601  AMT*B6*448.4
602  LX*48
603  CLP*RHP100840*1*269*92.16*40*CI*999020631048*11*1
604  NM1*QC*1*SYNTHETIC*PATIENT100840****MI*ZZ0100840
605  DTM*232*20260912
606  DTM*233*20260912
607  SVC*HC:99203*269*92.16**1
608  DTM*472*20260912
609  CAS*CO*45*136.84
610  CAS*PR*3*40
611  REF*6R*RHP100840-1
612  AMT*B6*132.16
613  LX*49
614  CLP*RHP100841*1*528*207.68*51.92*CI*999020631049*11*1
615  NM1*QC*1*SYNTHETIC*PATIENT100841****MI*ZZ0100841
616  DTM*232*20260911
617  DTM*233*20260911
618  SVC*HC:93306*528*207.68**1
619  DTM*472*20260911
620  CAS*CO*45*268.4
621  CAS*PR*2*51.92
622  REF*6R*RHP100841-1
623  AMT*B6*259.6
624  LX*50
625  CLP*RHP100842*1*449*220.66*0*CI*999020631050*11*1
626  NM1*QC*1*SYNTHETIC*PATIENT100842****MI*ZZ0100842
627  DTM*232*20260910
628  DTM*233*20260910
629  SVC*HC:99204*408*200.6**1
630  DTM*472*20260910
631  CAS*CO*45*207.4
632  REF*6R*RHP100842-1
633  AMT*B6*200.6
634  SVC*HC:93000*41*20.06**1
635  DTM*472*20260910
636  CAS*CO*45*20.94
637  REF*6R*RHP100842-2
638  AMT*B6*20.06
639  LX*51
640  CLP*RHP100843*1*2520*1127.49*0*CI*999020631051*11*1
641  NM1*QC*1*SYNTHETIC*PATIENT100843****MI*ZZ0100843
642  DTM*232*20260909
643  DTM*233*20260909
644  SVC*HC:29827*2520*1127.49**1
645  DTM*472*20260909
646  CAS*CO*45*1392.51
647  REF*6R*RHP100843-1
648  AMT*B6*1127.49
649  LX*52
650  CLP*RHP100844*1*140*54.75*13.69*CI*999020631052*11*1
651  NM1*QC*1*SYNTHETIC*PATIENT100844****MI*ZZ0100844
652  DTM*232*20260908
653  DTM*233*20260908
654  SVC*HC:97110*140*54.75**2
655  DTM*472*20260908
656  CAS*CO*45*71.56
657  CAS*PR*2*13.69
658  REF*6R*RHP100844-1
659  AMT*B6*68.44
660  LX*53
661  CLP*RHP100845*1*576*233.2*50*CI*999020631053*11*1
662  NM1*QC*1*SYNTHETIC*PATIENT100845****MI*ZZ0100845
663  DTM*232*20260907
664  DTM*233*20260907
665  SVC*HC:64483*576*233.2**1
666  DTM*472*20260907
667  CAS*CO*45*292.8
668  CAS*PR*3*50
669  REF*6R*RHP100845-1
670  AMT*B6*283.2
671  LX*54
672  CLP*RHP100846*1*310*152.22*0*CI*999020631054*11*1
673  NM1*QC*1*SYNTHETIC*PATIENT100846****MI*ZZ0100846
674  DTM*232*20260906
675  DTM*233*20260906
676  SVC*HC:99213*221*108.56**1
677  DTM*472*20260906
678  CAS*CO*45*112.44
679  REF*6R*RHP100846-1
680  AMT*B6*108.56
681  SVC*HC:90471*41*20.06**1
682  DTM*472*20260906
683  CAS*CO*45*20.94
684  REF*6R*RHP100846-2
685  AMT*B6*20.06
686  SVC*HC:90686*48*23.6**1
687  DTM*472*20260906
688  CAS*CO*45*24.4
689  REF*6R*RHP100846-3
690  AMT*B6*23.6
691  LX*55
692  CLP*RHP100847*1*338*66.38*100*CI*999020631055*11*1
693  NM1*QC*1*SYNTHETIC*PATIENT100847****MI*ZZ0100847
694  DTM*232*20260905
695  DTM*233*20260905
696  SVC*HC:99214*312*53.4**1
697  DTM*472*20260905
698  CAS*CO*45*158.6
699  CAS*PR*1*100
700  REF*6R*RHP100847-1
701  AMT*B6*153.4
702  SVC*HC:80053*26*12.98**1
703  DTM*472*20260905
704  CAS*CO*45*13.02
705  REF*6R*RHP100847-2
706  AMT*B6*12.98
707  LX*56
708  CLP*RHP100848*4*228*0*0*CI*999020631056*11*1
709  NM1*QC*1*SYNTHETIC*PATIENT100848****MI*ZZ0100848
710  DTM*232*20260904
711  DTM*233*20260904
712  SVC*HC:99213*221*0**1
713  DTM*472*20260904
714  CAS*CO*4*221
715  REF*6R*RHP100848-1
716  AMT*B6*0
717  SVC*HC:36415*7*0**1
718  DTM*472*20260904
719  CAS*CO*4*7
720  REF*6R*RHP100848-2
721  AMT*B6*0
722  LX*57
723  CLP*RHP100849*1*1728*773.14*0*CI*999020631057*11*1
724  NM1*QC*1*SYNTHETIC*PATIENT100849****MI*ZZ0100849
725  DTM*232*20260903
726  DTM*233*20260903
727  SVC*HC:29881*1728*773.14**1
728  DTM*472*20260903
729  CAS*CO*45*954.86
730  REF*6R*RHP100849-1
731  AMT*B6*773.14
732  LX*58
733  CLP*RHP100850*1*319*125.55*31.39*CI*999020631058*11*1
734  NM1*QC*1*SYNTHETIC*PATIENT100850****MI*ZZ0100850
735  DTM*232*20260902
736  DTM*233*20260902
737  SVC*HC:99214*312*122.72**1
738  DTM*472*20260902
739  CAS*CO*45*158.6
740  CAS*PR*2*30.68
741  REF*6R*RHP100850-1
742  AMT*B6*153.4
743  SVC*HC:36415*7*2.83**1
744  DTM*472*20260902
745  CAS*CO*45*3.46
746  CAS*PR*2*0.71
747  REF*6R*RHP100850-2
748  AMT*B6*3.54
749  LX*59
750  CLP*RHP100851*1*624*156.8*150*CI*999020631059*11*1
751  NM1*QC*1*SYNTHETIC*PATIENT100851****MI*ZZ0100851
752  DTM*232*20260901
753  DTM*233*20260901
754  SVC*HC:73721*624*156.8**1
755  DTM*472*20260901
756  CAS*CO*45*317.2
757  CAS*PR*1*150
758  REF*6R*RHP100851-1
759  AMT*B6*306.8
760  LX*60
761  CLP*RHP100852*1*240*118*0*CI*999020631060*11*1
762  NM1*QC*1*SYNTHETIC*PATIENT100852****MI*ZZ0100852
763  DTM*232*20260831
764  DTM*233*20260831
765  SVC*HC:99213*221*108.56**1
766  DTM*472*20260831
767  CAS*CO*45*112.44
768  REF*6R*RHP100852-1
769  AMT*B6*108.56
770  SVC*HC:85025*19*9.44**1
771  DTM*472*20260831
772  CAS*CO*45*9.56
773  REF*6R*RHP100852-2
774  AMT*B6*9.44
775  LX*61
776  CLP*RHP100853*1*3480*1557.01*0*CI*999020631061*11*1
777  NM1*QC*1*SYNTHETIC*PATIENT100853****MI*ZZ0100853
778  DTM*232*20260830
779  DTM*233*20260830
780  SVC*HC:27447*3480*1557.01**1
781  DTM*472*20260830
782  CAS*CO*45*1922.99
783  REF*6R*RHP100853-1
784  AMT*B6*1557.01
785  LX*62
786  CLP*RHP100854*1*439*194.35*21.59*CI*999020631062*11*1
787  NM1*QC*1*SYNTHETIC*PATIENT100854****MI*ZZ0100854
788  DTM*232*20260916
789  DTM*233*20260916
790  SVC*HC:99215*439*194.35**1
791  DTM*472*20260916
792  CAS*CO*45*223.06
793  CAS*PR*2*21.59
794  REF*6R*RHP100854-1
795  AMT*B6*215.94
796  LX*63
797  CLP*RHP100855*1*912*448.4*0*CI*999020631063*11*1
798  NM1*QC*1*SYNTHETIC*PATIENT100855****MI*ZZ0100855
799  DTM*232*20260915
800  DTM*233*20260915
801  SVC*HC:45380*912*448.4**1
802  DTM*472*20260915
803  CAS*CO*45*463.6
804  REF*6R*RHP100855-1
805  AMT*B6*448.4
806  LX*64
807  CLP*RHP100856*1*269*92.16*40*CI*999020631064*11*1
808  NM1*QC*1*SYNTHETIC*PATIENT100856****MI*ZZ0100856
809  DTM*232*20260914
810  DTM*233*20260914
811  SVC*HC:99203*269*92.16**1
812  DTM*472*20260914
813  CAS*CO*45*136.84
814  CAS*PR*3*40
815  REF*6R*RHP100856-1
816  AMT*B6*132.16
817  LX*65
818  CLP*RHP100857*1*528*207.68*51.92*CI*999020631065*11*1
819  NM1*QC*1*SYNTHETIC*PATIENT100857****MI*ZZ0100857
820  DTM*232*20260913
821  DTM*233*20260913
822  SVC*HC:93306*528*207.68**1
823  DTM*472*20260913
824  CAS*CO*45*268.4
825  CAS*PR*2*51.92
826  REF*6R*RHP100857-1
827  AMT*B6*259.6
828  LX*66
829  CLP*RHP100858*1*449*220.66*0*CI*999020631066*11*1
830  NM1*QC*1*SYNTHETIC*PATIENT100858****MI*ZZ0100858
831  DTM*232*20260912
832  DTM*233*20260912
833  SVC*HC:99204*408*200.6**1
834  DTM*472*20260912
835  CAS*CO*45*207.4
836  REF*6R*RHP100858-1
837  AMT*B6*200.6
838  SVC*HC:93000*41*20.06**1
839  DTM*472*20260912
840  CAS*CO*45*20.94
841  REF*6R*RHP100858-2
842  AMT*B6*20.06
843  LX*67
844  CLP*RHP100859*1*2520*1127.49*0*CI*999020631067*11*1
845  NM1*QC*1*SYNTHETIC*PATIENT100859****MI*ZZ0100859
846  DTM*232*20260911
847  DTM*233*20260911
848  SVC*HC:29827*2520*1127.49**1
849  DTM*472*20260911
850  CAS*CO*45*1392.51
851  REF*6R*RHP100859-1
852  AMT*B6*1127.49
853  SE*851*0001
854  GE*1*108
855  IEA*1*000000108