Remittances / SM9990031177

Silver Mesa Senior Advantage

Payment SM9990031177, electronic funds transfer dated Sep 7, 2026. From SMA_REMIT_A.txt, imported Sep 8, 2026 by Dana Whitfield.

Balances to the cent

Export CSV

Payments dated Sep 7, 2026 to Sep 7, 2026, as of Oct 6, 2026. Whole organization, every site.

Payment

$15,300.53

Electronic funds transfer

Claims

68 matched to billed claims

Claim payments

$15,300.53

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
RHP100121	Claim number matched exactly	Paid as expected	$345.00	$144.00	$112.89 patient $28.80	$28.80
RHP100122	Claim number matched exactly	Paid as expected	$439.00	$183.00	$143.47 patient $36.60	$36.60
RHP100123	Claim number matched exactly	Partially denied	$353.00	$130.00	$101.92 patient $26.00	$26.00	$17.00
RHP100124	Claim number matched exactly	Paid as expected	$377.00	$157.00	$123.09 patient $31.40	$31.40
RHP100125	Claim number matched exactly	Denied	$408.00	$0.00	$0.00	$0.00	$170.00
RHP100126	Claim number matched exactly	Paid as expected	$221.00	$92.00	$40.77 patient $50.40	$50.40
RHP100127	Claim number matched exactly	Underpaid	$624.00	$247.00	$193.65 patient $49.40	$49.40	$13.00
RHP100222	Claim number matched exactly	Paid as expected	$1,728.00	$720.00	$564.48 patient $144.00	$144.00
RHP100500	Claim number matched exactly	Paid as expected	$240.00	$100.00	$78.40 patient $20.00	$20.00
RHP100501	Claim number matched exactly	Paid as expected	$3,480.00	$1,450.00	$1,136.80 patient $290.00	$290.00
RHP100502	Claim number matched exactly	Paid as expected	$439.00	$183.00	$143.47 patient $36.60	$36.60
RHP100503	Claim number matched exactly	Paid as expected	$912.00	$380.00	$297.92 patient $76.00	$76.00
RHP100504	Claim number matched exactly	Paid as expected	$269.00	$112.00	$87.81 patient $22.40	$22.40
RHP100505	Claim number matched exactly	Paid as expected	$528.00	$220.00	$172.48 patient $44.00	$44.00
RHP100506	Claim number matched exactly	Paid as expected	$449.00	$187.00	$146.61 patient $37.40	$37.40
RHP100507	Claim number matched exactly	Paid as expected	$2,520.00	$1,050.00	$823.20 patient $210.00	$210.00
RHP100508	Claim number matched exactly	Paid as expected	$140.00	$58.00	$45.47 patient $11.60	$11.60
RHP100509	Claim number matched exactly	Paid as expected	$576.00	$240.00	$188.16 patient $48.00	$48.00
RHP100510	Claim number matched exactly	Denied	$310.00	$0.00	$0.00	$0.00	$129.00
RHP100511	Claim number matched exactly	Paid as expected	$338.00	$141.00	$110.54 patient $28.20	$28.20
RHP100512	Claim number matched exactly	Paid as expected	$228.00	$95.00	$74.48 patient $19.00	$19.00
RHP100513	Claim number matched exactly	Paid as expected	$1,728.00	$720.00	$564.48 patient $144.00	$144.00
RHP100514	Claim number matched exactly	Paid as expected	$319.00	$133.00	$104.27 patient $26.60	$26.60
RHP100515	Claim number matched exactly	Paid as expected	$624.00	$260.00	$203.84 patient $52.00	$52.00
RHP100516	Claim number matched exactly	Paid as expected	$240.00	$100.00	$78.40 patient $20.00	$20.00
RHP100517	Claim number matched exactly	Paid as expected	$3,480.00	$1,450.00	$1,136.80 patient $290.00	$290.00
RHP100518	Claim number matched exactly	Paid as expected	$439.00	$183.00	$143.47 patient $36.60	$36.60
RHP100519	Claim number matched exactly	Paid as expected	$912.00	$380.00	$297.92 patient $76.00	$76.00
RHP100520	Claim number matched exactly	Paid as expected	$269.00	$112.00	$87.81 patient $22.40	$22.40
RHP100521	Claim number matched exactly	Paid as expected	$528.00	$220.00	$172.48 patient $44.00	$44.00
RHP100522	Claim number matched exactly	Paid as expected	$449.00	$187.00	$146.61 patient $37.40	$37.40
RHP100523	Claim number matched exactly	Denied	$2,520.00	$0.00	$0.00	$0.00	$1,050.00
RHP100524	Claim number matched exactly	Paid as expected	$140.00	$58.00	$45.47 patient $11.60	$11.60
RHP100525	Claim number matched exactly	Paid as expected	$576.00	$240.00	$188.16 patient $48.00	$48.00
RHP100526	Claim number matched exactly	Paid as expected	$310.00	$129.00	$101.14 patient $25.80	$25.80
RHP100527	Claim number matched exactly	Paid as expected	$338.00	$141.00	$110.54 patient $28.20	$28.20
RHP100528	Claim number matched exactly	Paid as expected	$228.00	$95.00	$74.48 patient $19.00	$19.00
RHP100529	Claim number matched exactly	Paid as expected	$1,728.00	$720.00	$564.48 patient $144.00	$144.00
RHP100530	Claim number matched exactly	Paid as expected	$319.00	$133.00	$104.27 patient $26.60	$26.60
RHP100531	Claim number matched exactly	Paid as expected	$624.00	$260.00	$203.84 patient $52.00	$52.00
RHP100532	Claim number matched exactly	Paid as expected	$240.00	$100.00	$78.40 patient $20.00	$20.00
RHP100533	Claim number matched exactly	Paid as expected	$3,480.00	$1,450.00	$1,136.80 patient $290.00	$290.00
RHP100534	Claim number matched exactly	Paid as expected	$439.00	$183.00	$143.47 patient $36.60	$36.60
RHP100535	Claim number matched exactly	Paid as expected	$912.00	$380.00	$297.92 patient $76.00	$76.00
RHP100536	Claim number matched exactly	Denied	$269.00	$0.00	$0.00	$0.00	$112.00
RHP100537	Claim number matched exactly	Paid as expected	$528.00	$220.00	$172.48 patient $44.00	$44.00
RHP100538	Claim number matched exactly	Paid as expected	$449.00	$187.00	$146.61 patient $37.40	$37.40
RHP100539	Claim number matched exactly	Paid as expected	$2,520.00	$1,050.00	$823.20 patient $210.00	$210.00
RHP100540	Claim number matched exactly	Paid as expected	$140.00	$58.00	$45.47 patient $11.60	$11.60
RHP100541	Claim number matched exactly	Paid as expected	$576.00	$240.00	$188.16 patient $48.00	$48.00
RHP100542	Claim number matched exactly	Paid as expected	$310.00	$129.00	$101.14 patient $25.80	$25.80
RHP100543	Claim number matched exactly	Paid as expected	$338.00	$141.00	$110.54 patient $28.20	$28.20
RHP100544	Claim number matched exactly	Paid as expected	$228.00	$95.00	$74.48 patient $19.00	$19.00
RHP100545	Claim number matched exactly	Paid as expected	$1,728.00	$720.00	$564.48 patient $144.00	$144.00
RHP100546	Claim number matched exactly	Paid as expected	$319.00	$133.00	$104.27 patient $26.60	$26.60
RHP100547	Claim number matched exactly	Paid as expected	$624.00	$260.00	$203.84 patient $52.00	$52.00
RHP100548	Claim number matched exactly	Paid as expected	$240.00	$100.00	$78.40 patient $20.00	$20.00
RHP100549	Claim number matched exactly	Denied	$3,480.00	$0.00	$0.00	$0.00	$1,450.00
RHP100550	Claim number matched exactly	Paid as expected	$439.00	$183.00	$143.47 patient $36.60	$36.60
RHP100551	Claim number matched exactly	Paid as expected	$912.00	$380.00	$297.92 patient $76.00	$76.00
RHP100552	Claim number matched exactly	Paid as expected	$269.00	$112.00	$87.81 patient $22.40	$22.40
RHP100553	Claim number matched exactly	Paid as expected	$528.00	$220.00	$172.48 patient $44.00	$44.00
RHP100554	Claim number matched exactly	Paid as expected	$449.00	$187.00	$146.61 patient $37.40	$37.40
RHP100555	Claim number matched exactly	Paid as expected	$2,520.00	$1,050.00	$823.20 patient $210.00	$210.00
RHP100556	Claim number matched exactly	Paid as expected	$140.00	$58.00	$45.47 patient $11.60	$11.60
RHP100557	Claim number matched exactly	Paid as expected	$576.00	$240.00	$188.16 patient $48.00	$48.00
RHP100558	Claim number matched exactly	Paid as expected	$310.00	$129.00	$101.14 patient $25.80	$25.80
RHP100559	Claim number matched exactly	Paid as expected	$338.00	$141.00	$110.54 patient $28.20	$28.20

Scroll sideways to see every column.

The payer's remittance file (835)

Payer ID 99903. Payee RIDGELINE HEALTH PARTNERS, NPI 9999999001. Transaction 0001, 931 segments.

Show the raw file (935 segments)

1  ISA*00*          *00*          *ZZ*PAYER99903     *ZZ*RIDGELINE999   *260906*0800*^*00501*000000105*0*T*:
2  GS*HP*PAYER99903*RIDGELINE999*20260906*0800*105*X*005010X221A1
3  ST*835*0001
4  BPR*I*15300.53*C*ACH*CCP*01*999999992*DA*000111222*1999999999**01*999999993*DA*000333444*20260907
5  TRN*1*SM9990031177*1999999903
6  DTM*405*20260906
7  N1*PR*SILVER MESA SENIOR ADVANTAGE
8  REF*2U*99903
9  N1*PE*RIDGELINE HEALTH PARTNERS*XX*9999999001
10  REF*TJ*999999999
11  LX*1
12  CLP*RHP100121*1*345*112.89*28.8*HM*999031177001*11*1
13  NM1*QC*1*SYNTHETIC*PATIENT100121****MI*ZZ0100121
14  DTM*232*20260815
15  DTM*233*20260815
16  SVC*HC:99214*312*101.92**1
17  DTM*472*20260815
18  CAS*CO*45*182**253*2.08
19  CAS*PR*2*26
20  REF*6R*RHP100121-1
21  AMT*B6*130
22  SVC*HC:36415*7*2.35**1
23  DTM*472*20260815
24  CAS*CO*45*4**253*0.05
25  CAS*PR*2*0.6
26  REF*6R*RHP100121-2
27  AMT*B6*3
28  SVC*HC:80053*26*8.62**1
29  DTM*472*20260815
30  CAS*CO*45*15**253*0.18
31  CAS*PR*2*2.2
32  REF*6R*RHP100121-3
33  AMT*B6*11
34  LX*2
35  CLP*RHP100122*1*439*143.47*36.6*HM*999031177002*11*1
36  NM1*QC*1*SYNTHETIC*PATIENT100122****MI*ZZ0100122
37  DTM*232*20260816
38  DTM*233*20260816
39  SVC*HC:99215*439*143.47**1
40  DTM*472*20260816
41  CAS*CO*45*256**253*2.93
42  CAS*PR*2*36.6
43  REF*6R*RHP100122-1
44  AMT*B6*183
45  LX*3
46  CLP*RHP100123*1*353*101.92*26*HM*999031177003*11*1
47  NM1*QC*1*SYNTHETIC*PATIENT100123****MI*ZZ0100123
48  DTM*232*20260817
49  DTM*233*20260817
50  SVC*HC:99214*312*101.92**1
51  DTM*472*20260817
52  CAS*CO*45*182**253*2.08
53  CAS*PR*2*26
54  REF*6R*RHP100123-1
55  AMT*B6*130
56  SVC*HC:93000*41*0**1
57  DTM*472*20260817
58  CAS*CO*50*41
59  REF*6R*RHP100123-2
60  AMT*B6*0
61  LQ*HE*N130
62  LX*4
63  CLP*RHP100124*1*377*123.09*31.4*HM*999031177004*11*1
64  NM1*QC*1*SYNTHETIC*PATIENT100124****MI*ZZ0100124
65  DTM*232*20260818
66  DTM*233*20260818
67  SVC*HC:99213:25*221*72.13**1
68  DTM*472*20260818
69  CAS*CO*45*129**253*1.47
70  CAS*PR*2*18.4
71  REF*6R*RHP100124-1
72  AMT*B6*92
73  SVC*HC:20610*156*50.96**1
74  DTM*472*20260818
75  CAS*CO*45*91**253*1.04
76  CAS*PR*2*13
77  REF*6R*RHP100124-2
78  AMT*B6*65
79  LX*5
80  CLP*RHP100125*4*408*0*0*HM*999031177005*11*1
81  NM1*QC*1*SYNTHETIC*PATIENT100125****MI*ZZ0100125
82  DTM*232*20260819
83  DTM*233*20260819
84  SVC*HC:99204*408*0**1
85  DTM*472*20260819
86  CAS*CO*185*408
87  REF*6R*RHP100125-1
88  AMT*B6*0
89  LQ*HE*N290
90  LX*6
91  CLP*RHP100126*1*221*40.77*50.4*HM*999031177006*11*1
92  NM1*QC*1*SYNTHETIC*PATIENT100126****MI*ZZ0100126
93  DTM*232*20260820
94  DTM*233*20260820
95  SVC*HC:99213*221*40.77**1
96  DTM*472*20260820
97  CAS*CO*45*129**253*0.83
98  CAS*PR*1*40**2*10.4
99  REF*6R*RHP100126-1
100  AMT*B6*92
101  LX*7
102  CLP*RHP100127*1*624*193.65*49.4*HM*999031177007*11*1
103  NM1*QC*1*SYNTHETIC*PATIENT100127****MI*ZZ0100127
104  DTM*232*20260821
105  DTM*233*20260821
106  SVC*HC:73721*624*193.65**1
107  DTM*472*20260821
108  CAS*CO*45*377**253*3.95
109  CAS*PR*2*49.4
110  REF*6R*RHP100127-1
111  AMT*B6*247
112  LX*8
113  CLP*RHP100222*1*1728*564.48*144*HM*999031177008C*11*1
114  NM1*QC*1*SYNTHETIC*PATIENT100222****MI*ZZ0100222
115  DTM*232*20260801
116  DTM*233*20260801
117  SVC*HC:29881*1728*564.48**1
118  DTM*472*20260801
119  CAS*CO*45*1008**253*11.52
120  CAS*PR*2*144
121  REF*6R*RHP100222-1
122  AMT*B6*720
123  LX*9
124  CLP*RHP100500*1*240*78.4*20*HM*999031177009*11*1
125  NM1*QC*1*SYNTHETIC*PATIENT100500****MI*ZZ0100500
126  DTM*232*20260826
127  DTM*233*20260826
128  SVC*HC:99213*221*72.13**1
129  DTM*472*20260826
130  CAS*CO*45*129**253*1.47
131  CAS*PR*2*18.4
132  REF*6R*RHP100500-1
133  AMT*B6*92
134  SVC*HC:85025*19*6.27**1
135  DTM*472*20260826
136  CAS*CO*45*11**253*0.13
137  CAS*PR*2*1.6
138  REF*6R*RHP100500-2
139  AMT*B6*8
140  LX*10
141  CLP*RHP100501*1*3480*1136.8*290*HM*999031177010*11*1
142  NM1*QC*1*SYNTHETIC*PATIENT100501****MI*ZZ0100501
143  DTM*232*20260825
144  DTM*233*20260825
145  SVC*HC:27447*3480*1136.8**1
146  DTM*472*20260825
147  CAS*CO*45*2030**253*23.2
148  CAS*PR*2*290
149  REF*6R*RHP100501-1
150  AMT*B6*1450
151  LX*11
152  CLP*RHP100502*1*439*143.47*36.6*HM*999031177011*11*1
153  NM1*QC*1*SYNTHETIC*PATIENT100502****MI*ZZ0100502
154  DTM*232*20260824
155  DTM*233*20260824
156  SVC*HC:99215*439*143.47**1
157  DTM*472*20260824
158  CAS*CO*45*256**253*2.93
159  CAS*PR*2*36.6
160  REF*6R*RHP100502-1
161  AMT*B6*183
162  LX*12
163  CLP*RHP100503*1*912*297.92*76*HM*999031177012*11*1
164  NM1*QC*1*SYNTHETIC*PATIENT100503****MI*ZZ0100503
165  DTM*232*20260823
166  DTM*233*20260823
167  SVC*HC:45380*912*297.92**1
168  DTM*472*20260823
169  CAS*CO*45*532**253*6.08
170  CAS*PR*2*76
171  REF*6R*RHP100503-1
172  AMT*B6*380
173  LX*13
174  CLP*RHP100504*1*269*87.81*22.4*HM*999031177013*11*1
175  NM1*QC*1*SYNTHETIC*PATIENT100504****MI*ZZ0100504
176  DTM*232*20260822
177  DTM*233*20260822
178  SVC*HC:99203*269*87.81**1
179  DTM*472*20260822
180  CAS*CO*45*157**253*1.79
181  CAS*PR*2*22.4
182  REF*6R*RHP100504-1
183  AMT*B6*112
184  LX*14
185  CLP*RHP100505*1*528*172.48*44*HM*999031177014*11*1
186  NM1*QC*1*SYNTHETIC*PATIENT100505****MI*ZZ0100505
187  DTM*232*20260821
188  DTM*233*20260821
189  SVC*HC:93306*528*172.48**1
190  DTM*472*20260821
191  CAS*CO*45*308**253*3.52
192  CAS*PR*2*44
193  REF*6R*RHP100505-1
194  AMT*B6*220
195  LX*15
196  CLP*RHP100506*1*449*146.61*37.4*HM*999031177015*11*1
197  NM1*QC*1*SYNTHETIC*PATIENT100506****MI*ZZ0100506
198  DTM*232*20260820
199  DTM*233*20260820
200  SVC*HC:99204*408*133.28**1
201  DTM*472*20260820
202  CAS*CO*45*238**253*2.72
203  CAS*PR*2*34
204  REF*6R*RHP100506-1
205  AMT*B6*170
206  SVC*HC:93000*41*13.33**1
207  DTM*472*20260820
208  CAS*CO*45*24**253*0.27
209  CAS*PR*2*3.4
210  REF*6R*RHP100506-2
211  AMT*B6*17
212  LX*16
213  CLP*RHP100507*1*2520*823.2*210*HM*999031177016*11*1
214  NM1*QC*1*SYNTHETIC*PATIENT100507****MI*ZZ0100507
215  DTM*232*20260819
216  DTM*233*20260819
217  SVC*HC:29827*2520*823.2**1
218  DTM*472*20260819
219  CAS*CO*45*1470**253*16.8
220  CAS*PR*2*210
221  REF*6R*RHP100507-1
222  AMT*B6*1050
223  LX*17
224  CLP*RHP100508*1*140*45.47*11.6*HM*999031177017*11*1
225  NM1*QC*1*SYNTHETIC*PATIENT100508****MI*ZZ0100508
226  DTM*232*20260818
227  DTM*233*20260818
228  SVC*HC:97110*140*45.47**2
229  DTM*472*20260818
230  CAS*CO*45*82**253*0.93
231  CAS*PR*2*11.6
232  REF*6R*RHP100508-1
233  AMT*B6*58
234  LX*18
235  CLP*RHP100509*1*576*188.16*48*HM*999031177018*11*1
236  NM1*QC*1*SYNTHETIC*PATIENT100509****MI*ZZ0100509
237  DTM*232*20260817
238  DTM*233*20260817
239  SVC*HC:64483*576*188.16**1
240  DTM*472*20260817
241  CAS*CO*45*336**253*3.84
242  CAS*PR*2*48
243  REF*6R*RHP100509-1
244  AMT*B6*240
245  LX*19
246  CLP*RHP100510*4*310*0*0*HM*999031177019*11*1
247  NM1*QC*1*SYNTHETIC*PATIENT100510****MI*ZZ0100510
248  DTM*232*20260816
249  DTM*233*20260816
250  SVC*HC:99213*221*0**1
251  DTM*472*20260816
252  CAS*CO*22*221
253  REF*6R*RHP100510-1
254  AMT*B6*0
255  SVC*HC:90471*41*0**1
256  DTM*472*20260816
257  CAS*CO*22*41
258  REF*6R*RHP100510-2
259  AMT*B6*0
260  SVC*HC:90686*48*0**1
261  DTM*472*20260816
262  CAS*CO*22*48
263  REF*6R*RHP100510-3
264  AMT*B6*0
265  LX*20
266  CLP*RHP100511*1*338*110.54*28.2*HM*999031177020*11*1
267  NM1*QC*1*SYNTHETIC*PATIENT100511****MI*ZZ0100511
268  DTM*232*20260815
269  DTM*233*20260815
270  SVC*HC:99214*312*101.92**1
271  DTM*472*20260815
272  CAS*CO*45*182**253*2.08
273  CAS*PR*2*26
274  REF*6R*RHP100511-1
275  AMT*B6*130
276  SVC*HC:80053*26*8.62**1
277  DTM*472*20260815
278  CAS*CO*45*15**253*0.18
279  CAS*PR*2*2.2
280  REF*6R*RHP100511-2
281  AMT*B6*11
282  LX*21
283  CLP*RHP100512*1*228*74.48*19*HM*999031177021*11*1
284  NM1*QC*1*SYNTHETIC*PATIENT100512****MI*ZZ0100512
285  DTM*232*20260814
286  DTM*233*20260814
287  SVC*HC:99213*221*72.13**1
288  DTM*472*20260814
289  CAS*CO*45*129**253*1.47
290  CAS*PR*2*18.4
291  REF*6R*RHP100512-1
292  AMT*B6*92
293  SVC*HC:36415*7*2.35**1
294  DTM*472*20260814
295  CAS*CO*45*4**253*0.05
296  CAS*PR*2*0.6
297  REF*6R*RHP100512-2
298  AMT*B6*3
299  LX*22
300  CLP*RHP100513*1*1728*564.48*144*HM*999031177022*11*1
301  NM1*QC*1*SYNTHETIC*PATIENT100513****MI*ZZ0100513
302  DTM*232*20260813
303  DTM*233*20260813
304  SVC*HC:29881*1728*564.48**1
305  DTM*472*20260813
306  CAS*CO*45*1008**253*11.52
307  CAS*PR*2*144
308  REF*6R*RHP100513-1
309  AMT*B6*720
310  LX*23
311  CLP*RHP100514*1*319*104.27*26.6*HM*999031177023*11*1
312  NM1*QC*1*SYNTHETIC*PATIENT100514****MI*ZZ0100514
313  DTM*232*20260812
314  DTM*233*20260812
315  SVC*HC:99214*312*101.92**1
316  DTM*472*20260812
317  CAS*CO*45*182**253*2.08
318  CAS*PR*2*26
319  REF*6R*RHP100514-1
320  AMT*B6*130
321  SVC*HC:36415*7*2.35**1
322  DTM*472*20260812
323  CAS*CO*45*4**253*0.05
324  CAS*PR*2*0.6
325  REF*6R*RHP100514-2
326  AMT*B6*3
327  LX*24
328  CLP*RHP100515*1*624*203.84*52*HM*999031177024*11*1
329  NM1*QC*1*SYNTHETIC*PATIENT100515****MI*ZZ0100515
330  DTM*232*20260811
331  DTM*233*20260811
332  SVC*HC:73721*624*203.84**1
333  DTM*472*20260811
334  CAS*CO*45*364**253*4.16
335  CAS*PR*2*52
336  REF*6R*RHP100515-1
337  AMT*B6*260
338  LX*25
339  CLP*RHP100516*1*240*78.4*20*HM*999031177025*11*1
340  NM1*QC*1*SYNTHETIC*PATIENT100516****MI*ZZ0100516
341  DTM*232*20260810
342  DTM*233*20260810
343  SVC*HC:99213*221*72.13**1
344  DTM*472*20260810
345  CAS*CO*45*129**253*1.47
346  CAS*PR*2*18.4
347  REF*6R*RHP100516-1
348  AMT*B6*92
349  SVC*HC:85025*19*6.27**1
350  DTM*472*20260810
351  CAS*CO*45*11**253*0.13
352  CAS*PR*2*1.6
353  REF*6R*RHP100516-2
354  AMT*B6*8
355  LX*26
356  CLP*RHP100517*1*3480*1136.8*290*HM*999031177026*11*1
357  NM1*QC*1*SYNTHETIC*PATIENT100517****MI*ZZ0100517
358  DTM*232*20260809
359  DTM*233*20260809
360  SVC*HC:27447*3480*1136.8**1
361  DTM*472*20260809
362  CAS*CO*45*2030**253*23.2
363  CAS*PR*2*290
364  REF*6R*RHP100517-1
365  AMT*B6*1450
366  LX*27
367  CLP*RHP100518*1*439*143.47*36.6*HM*999031177027*11*1
368  NM1*QC*1*SYNTHETIC*PATIENT100518****MI*ZZ0100518
369  DTM*232*20260826
370  DTM*233*20260826
371  SVC*HC:99215*439*143.47**1
372  DTM*472*20260826
373  CAS*CO*45*256**253*2.93
374  CAS*PR*2*36.6
375  REF*6R*RHP100518-1
376  AMT*B6*183
377  LX*28
378  CLP*RHP100519*1*912*297.92*76*HM*999031177028*11*1
379  NM1*QC*1*SYNTHETIC*PATIENT100519****MI*ZZ0100519
380  DTM*232*20260825
381  DTM*233*20260825
382  SVC*HC:45380*912*297.92**1
383  DTM*472*20260825
384  CAS*CO*45*532**253*6.08
385  CAS*PR*2*76
386  REF*6R*RHP100519-1
387  AMT*B6*380
388  LX*29
389  CLP*RHP100520*1*269*87.81*22.4*HM*999031177029*11*1
390  NM1*QC*1*SYNTHETIC*PATIENT100520****MI*ZZ0100520
391  DTM*232*20260824
392  DTM*233*20260824
393  SVC*HC:99203*269*87.81**1
394  DTM*472*20260824
395  CAS*CO*45*157**253*1.79
396  CAS*PR*2*22.4
397  REF*6R*RHP100520-1
398  AMT*B6*112
399  LX*30
400  CLP*RHP100521*1*528*172.48*44*HM*999031177030*11*1
401  NM1*QC*1*SYNTHETIC*PATIENT100521****MI*ZZ0100521
402  DTM*232*20260823
403  DTM*233*20260823
404  SVC*HC:93306*528*172.48**1
405  DTM*472*20260823
406  CAS*CO*45*308**253*3.52
407  CAS*PR*2*44
408  REF*6R*RHP100521-1
409  AMT*B6*220
410  LX*31
411  CLP*RHP100522*1*449*146.61*37.4*HM*999031177031*11*1
412  NM1*QC*1*SYNTHETIC*PATIENT100522****MI*ZZ0100522
413  DTM*232*20260822
414  DTM*233*20260822
415  SVC*HC:99204*408*133.28**1
416  DTM*472*20260822
417  CAS*CO*45*238**253*2.72
418  CAS*PR*2*34
419  REF*6R*RHP100522-1
420  AMT*B6*170
421  SVC*HC:93000*41*13.33**1
422  DTM*472*20260822
423  CAS*CO*45*24**253*0.27
424  CAS*PR*2*3.4
425  REF*6R*RHP100522-2
426  AMT*B6*17
427  LX*32
428  CLP*RHP100523*4*2520*0*0*HM*999031177032*11*1
429  NM1*QC*1*SYNTHETIC*PATIENT100523****MI*ZZ0100523
430  DTM*232*20260821
431  DTM*233*20260821
432  SVC*HC:29827*2520*0**1
433  DTM*472*20260821
434  CAS*CO*197*2520
435  REF*6R*RHP100523-1
436  AMT*B6*0
437  LX*33
438  CLP*RHP100524*1*140*45.47*11.6*HM*999031177033*11*1
439  NM1*QC*1*SYNTHETIC*PATIENT100524****MI*ZZ0100524
440  DTM*232*20260820
441  DTM*233*20260820
442  SVC*HC:97110*140*45.47**2
443  DTM*472*20260820
444  CAS*CO*45*82**253*0.93
445  CAS*PR*2*11.6
446  REF*6R*RHP100524-1
447  AMT*B6*58
448  LX*34
449  CLP*RHP100525*1*576*188.16*48*HM*999031177034*11*1
450  NM1*QC*1*SYNTHETIC*PATIENT100525****MI*ZZ0100525
451  DTM*232*20260819
452  DTM*233*20260819
453  SVC*HC:64483*576*188.16**1
454  DTM*472*20260819
455  CAS*CO*45*336**253*3.84
456  CAS*PR*2*48
457  REF*6R*RHP100525-1
458  AMT*B6*240
459  LX*35
460  CLP*RHP100526*1*310*101.14*25.8*HM*999031177035*11*1
461  NM1*QC*1*SYNTHETIC*PATIENT100526****MI*ZZ0100526
462  DTM*232*20260818
463  DTM*233*20260818
464  SVC*HC:99213*221*72.13**1
465  DTM*472*20260818
466  CAS*CO*45*129**253*1.47
467  CAS*PR*2*18.4
468  REF*6R*RHP100526-1
469  AMT*B6*92
470  SVC*HC:90471*41*13.33**1
471  DTM*472*20260818
472  CAS*CO*45*24**253*0.27
473  CAS*PR*2*3.4
474  REF*6R*RHP100526-2
475  AMT*B6*17
476  SVC*HC:90686*48*15.68**1
477  DTM*472*20260818
478  CAS*CO*45*28**253*0.32
479  CAS*PR*2*4
480  REF*6R*RHP100526-3
481  AMT*B6*20
482  LX*36
483  CLP*RHP100527*1*338*110.54*28.2*HM*999031177036*11*1
484  NM1*QC*1*SYNTHETIC*PATIENT100527****MI*ZZ0100527
485  DTM*232*20260817
486  DTM*233*20260817
487  SVC*HC:99214*312*101.92**1
488  DTM*472*20260817
489  CAS*CO*45*182**253*2.08
490  CAS*PR*2*26
491  REF*6R*RHP100527-1
492  AMT*B6*130
493  SVC*HC:80053*26*8.62**1
494  DTM*472*20260817
495  CAS*CO*45*15**253*0.18
496  CAS*PR*2*2.2
497  REF*6R*RHP100527-2
498  AMT*B6*11
499  LX*37
500  CLP*RHP100528*1*228*74.48*19*HM*999031177037*11*1
501  NM1*QC*1*SYNTHETIC*PATIENT100528****MI*ZZ0100528
502  DTM*232*20260816
503  DTM*233*20260816
504  SVC*HC:99213*221*72.13**1
505  DTM*472*20260816
506  CAS*CO*45*129**253*1.47
507  CAS*PR*2*18.4
508  REF*6R*RHP100528-1
509  AMT*B6*92
510  SVC*HC:36415*7*2.35**1
511  DTM*472*20260816
512  CAS*CO*45*4**253*0.05
513  CAS*PR*2*0.6
514  REF*6R*RHP100528-2
515  AMT*B6*3
516  LX*38
517  CLP*RHP100529*1*1728*564.48*144*HM*999031177038*11*1
518  NM1*QC*1*SYNTHETIC*PATIENT100529****MI*ZZ0100529
519  DTM*232*20260815
520  DTM*233*20260815
521  SVC*HC:29881*1728*564.48**1
522  DTM*472*20260815
523  CAS*CO*45*1008**253*11.52
524  CAS*PR*2*144
525  REF*6R*RHP100529-1
526  AMT*B6*720
527  LX*39
528  CLP*RHP100530*1*319*104.27*26.6*HM*999031177039*11*1
529  NM1*QC*1*SYNTHETIC*PATIENT100530****MI*ZZ0100530
530  DTM*232*20260814
531  DTM*233*20260814
532  SVC*HC:99214*312*101.92**1
533  DTM*472*20260814
534  CAS*CO*45*182**253*2.08
535  CAS*PR*2*26
536  REF*6R*RHP100530-1
537  AMT*B6*130
538  SVC*HC:36415*7*2.35**1
539  DTM*472*20260814
540  CAS*CO*45*4**253*0.05
541  CAS*PR*2*0.6
542  REF*6R*RHP100530-2
543  AMT*B6*3
544  LX*40
545  CLP*RHP100531*1*624*203.84*52*HM*999031177040*11*1
546  NM1*QC*1*SYNTHETIC*PATIENT100531****MI*ZZ0100531
547  DTM*232*20260813
548  DTM*233*20260813
549  SVC*HC:73721*624*203.84**1
550  DTM*472*20260813
551  CAS*CO*45*364**253*4.16
552  CAS*PR*2*52
553  REF*6R*RHP100531-1
554  AMT*B6*260
555  LX*41
556  CLP*RHP100532*1*240*78.4*20*HM*999031177041*11*1
557  NM1*QC*1*SYNTHETIC*PATIENT100532****MI*ZZ0100532
558  DTM*232*20260812
559  DTM*233*20260812
560  SVC*HC:99213*221*72.13**1
561  DTM*472*20260812
562  CAS*CO*45*129**253*1.47
563  CAS*PR*2*18.4
564  REF*6R*RHP100532-1
565  AMT*B6*92
566  SVC*HC:85025*19*6.27**1
567  DTM*472*20260812
568  CAS*CO*45*11**253*0.13
569  CAS*PR*2*1.6
570  REF*6R*RHP100532-2
571  AMT*B6*8
572  LX*42
573  CLP*RHP100533*1*3480*1136.8*290*HM*999031177042*11*1
574  NM1*QC*1*SYNTHETIC*PATIENT100533****MI*ZZ0100533
575  DTM*232*20260811
576  DTM*233*20260811
577  SVC*HC:27447*3480*1136.8**1
578  DTM*472*20260811
579  CAS*CO*45*2030**253*23.2
580  CAS*PR*2*290
581  REF*6R*RHP100533-1
582  AMT*B6*1450
583  LX*43
584  CLP*RHP100534*1*439*143.47*36.6*HM*999031177043*11*1
585  NM1*QC*1*SYNTHETIC*PATIENT100534****MI*ZZ0100534
586  DTM*232*20260810
587  DTM*233*20260810
588  SVC*HC:99215*439*143.47**1
589  DTM*472*20260810
590  CAS*CO*45*256**253*2.93
591  CAS*PR*2*36.6
592  REF*6R*RHP100534-1
593  AMT*B6*183
594  LX*44
595  CLP*RHP100535*1*912*297.92*76*HM*999031177044*11*1
596  NM1*QC*1*SYNTHETIC*PATIENT100535****MI*ZZ0100535
597  DTM*232*20260809
598  DTM*233*20260809
599  SVC*HC:45380*912*297.92**1
600  DTM*472*20260809
601  CAS*CO*45*532**253*6.08
602  CAS*PR*2*76
603  REF*6R*RHP100535-1
604  AMT*B6*380
605  LX*45
606  CLP*RHP100536*4*269*0*0*HM*999031177045*11*1
607  NM1*QC*1*SYNTHETIC*PATIENT100536****MI*ZZ0100536
608  DTM*232*20260826
609  DTM*233*20260826
610  SVC*HC:99203*269*0**1
611  DTM*472*20260826
612  CAS*CO*4*269
613  REF*6R*RHP100536-1
614  AMT*B6*0
615  LX*46
616  CLP*RHP100537*1*528*172.48*44*HM*999031177046*11*1
617  NM1*QC*1*SYNTHETIC*PATIENT100537****MI*ZZ0100537
618  DTM*232*20260825
619  DTM*233*20260825
620  SVC*HC:93306*528*172.48**1
621  DTM*472*20260825
622  CAS*CO*45*308**253*3.52
623  CAS*PR*2*44
624  REF*6R*RHP100537-1
625  AMT*B6*220
626  LX*47
627  CLP*RHP100538*1*449*146.61*37.4*HM*999031177047*11*1
628  NM1*QC*1*SYNTHETIC*PATIENT100538****MI*ZZ0100538
629  DTM*232*20260824
630  DTM*233*20260824
631  SVC*HC:99204*408*133.28**1
632  DTM*472*20260824
633  CAS*CO*45*238**253*2.72
634  CAS*PR*2*34
635  REF*6R*RHP100538-1
636  AMT*B6*170
637  SVC*HC:93000*41*13.33**1
638  DTM*472*20260824
639  CAS*CO*45*24**253*0.27
640  CAS*PR*2*3.4
641  REF*6R*RHP100538-2
642  AMT*B6*17
643  LX*48
644  CLP*RHP100539*1*2520*823.2*210*HM*999031177048*11*1
645  NM1*QC*1*SYNTHETIC*PATIENT100539****MI*ZZ0100539
646  DTM*232*20260823
647  DTM*233*20260823
648  SVC*HC:29827*2520*823.2**1
649  DTM*472*20260823
650  CAS*CO*45*1470**253*16.8
651  CAS*PR*2*210
652  REF*6R*RHP100539-1
653  AMT*B6*1050
654  LX*49
655  CLP*RHP100540*1*140*45.47*11.6*HM*999031177049*11*1
656  NM1*QC*1*SYNTHETIC*PATIENT100540****MI*ZZ0100540
657  DTM*232*20260822
658  DTM*233*20260822
659  SVC*HC:97110*140*45.47**2
660  DTM*472*20260822
661  CAS*CO*45*82**253*0.93
662  CAS*PR*2*11.6
663  REF*6R*RHP100540-1
664  AMT*B6*58
665  LX*50
666  CLP*RHP100541*1*576*188.16*48*HM*999031177050*11*1
667  NM1*QC*1*SYNTHETIC*PATIENT100541****MI*ZZ0100541
668  DTM*232*20260821
669  DTM*233*20260821
670  SVC*HC:64483*576*188.16**1
671  DTM*472*20260821
672  CAS*CO*45*336**253*3.84
673  CAS*PR*2*48
674  REF*6R*RHP100541-1
675  AMT*B6*240
676  LX*51
677  CLP*RHP100542*1*310*101.14*25.8*HM*999031177051*11*1
678  NM1*QC*1*SYNTHETIC*PATIENT100542****MI*ZZ0100542
679  DTM*232*20260820
680  DTM*233*20260820
681  SVC*HC:99213*221*72.13**1
682  DTM*472*20260820
683  CAS*CO*45*129**253*1.47
684  CAS*PR*2*18.4
685  REF*6R*RHP100542-1
686  AMT*B6*92
687  SVC*HC:90471*41*13.33**1
688  DTM*472*20260820
689  CAS*CO*45*24**253*0.27
690  CAS*PR*2*3.4
691  REF*6R*RHP100542-2
692  AMT*B6*17
693  SVC*HC:90686*48*15.68**1
694  DTM*472*20260820
695  CAS*CO*45*28**253*0.32
696  CAS*PR*2*4
697  REF*6R*RHP100542-3
698  AMT*B6*20
699  LX*52
700  CLP*RHP100543*1*338*110.54*28.2*HM*999031177052*11*1
701  NM1*QC*1*SYNTHETIC*PATIENT100543****MI*ZZ0100543
702  DTM*232*20260819
703  DTM*233*20260819
704  SVC*HC:99214*312*101.92**1
705  DTM*472*20260819
706  CAS*CO*45*182**253*2.08
707  CAS*PR*2*26
708  REF*6R*RHP100543-1
709  AMT*B6*130
710  SVC*HC:80053*26*8.62**1
711  DTM*472*20260819
712  CAS*CO*45*15**253*0.18
713  CAS*PR*2*2.2
714  REF*6R*RHP100543-2
715  AMT*B6*11
716  LX*53
717  CLP*RHP100544*1*228*74.48*19*HM*999031177053*11*1
718  NM1*QC*1*SYNTHETIC*PATIENT100544****MI*ZZ0100544
719  DTM*232*20260818
720  DTM*233*20260818
721  SVC*HC:99213*221*72.13**1
722  DTM*472*20260818
723  CAS*CO*45*129**253*1.47
724  CAS*PR*2*18.4
725  REF*6R*RHP100544-1
726  AMT*B6*92
727  SVC*HC:36415*7*2.35**1
728  DTM*472*20260818
729  CAS*CO*45*4**253*0.05
730  CAS*PR*2*0.6
731  REF*6R*RHP100544-2
732  AMT*B6*3
733  LX*54
734  CLP*RHP100545*1*1728*564.48*144*HM*999031177054*11*1
735  NM1*QC*1*SYNTHETIC*PATIENT100545****MI*ZZ0100545
736  DTM*232*20260817
737  DTM*233*20260817
738  SVC*HC:29881*1728*564.48**1
739  DTM*472*20260817
740  CAS*CO*45*1008**253*11.52
741  CAS*PR*2*144
742  REF*6R*RHP100545-1
743  AMT*B6*720
744  LX*55
745  CLP*RHP100546*1*319*104.27*26.6*HM*999031177055*11*1
746  NM1*QC*1*SYNTHETIC*PATIENT100546****MI*ZZ0100546
747  DTM*232*20260816
748  DTM*233*20260816
749  SVC*HC:99214*312*101.92**1
750  DTM*472*20260816
751  CAS*CO*45*182**253*2.08
752  CAS*PR*2*26
753  REF*6R*RHP100546-1
754  AMT*B6*130
755  SVC*HC:36415*7*2.35**1
756  DTM*472*20260816
757  CAS*CO*45*4**253*0.05
758  CAS*PR*2*0.6
759  REF*6R*RHP100546-2
760  AMT*B6*3
761  LX*56
762  CLP*RHP100547*1*624*203.84*52*HM*999031177056*11*1
763  NM1*QC*1*SYNTHETIC*PATIENT100547****MI*ZZ0100547
764  DTM*232*20260815
765  DTM*233*20260815
766  SVC*HC:73721*624*203.84**1
767  DTM*472*20260815
768  CAS*CO*45*364**253*4.16
769  CAS*PR*2*52
770  REF*6R*RHP100547-1
771  AMT*B6*260
772  LX*57
773  CLP*RHP100548*1*240*78.4*20*HM*999031177057*11*1
774  NM1*QC*1*SYNTHETIC*PATIENT100548****MI*ZZ0100548
775  DTM*232*20260814
776  DTM*233*20260814
777  SVC*HC:99213*221*72.13**1
778  DTM*472*20260814
779  CAS*CO*45*129**253*1.47
780  CAS*PR*2*18.4
781  REF*6R*RHP100548-1
782  AMT*B6*92
783  SVC*HC:85025*19*6.27**1
784  DTM*472*20260814
785  CAS*CO*45*11**253*0.13
786  CAS*PR*2*1.6
787  REF*6R*RHP100548-2
788  AMT*B6*8
789  LX*58
790  CLP*RHP100549*4*3480*0*0*HM*999031177058*11*1
791  NM1*QC*1*SYNTHETIC*PATIENT100549****MI*ZZ0100549
792  DTM*232*20260813
793  DTM*233*20260813
794  SVC*HC:27447*3480*0**1
795  DTM*472*20260813
796  CAS*CO*27*3480
797  REF*6R*RHP100549-1
798  AMT*B6*0
799  LX*59
800  CLP*RHP100550*1*439*143.47*36.6*HM*999031177059*11*1
801  NM1*QC*1*SYNTHETIC*PATIENT100550****MI*ZZ0100550
802  DTM*232*20260812
803  DTM*233*20260812
804  SVC*HC:99215*439*143.47**1
805  DTM*472*20260812
806  CAS*CO*45*256**253*2.93
807  CAS*PR*2*36.6
808  REF*6R*RHP100550-1
809  AMT*B6*183
810  LX*60
811  CLP*RHP100551*1*912*297.92*76*HM*999031177060*11*1
812  NM1*QC*1*SYNTHETIC*PATIENT100551****MI*ZZ0100551
813  DTM*232*20260811
814  DTM*233*20260811
815  SVC*HC:45380*912*297.92**1
816  DTM*472*20260811
817  CAS*CO*45*532**253*6.08
818  CAS*PR*2*76
819  REF*6R*RHP100551-1
820  AMT*B6*380
821  LX*61
822  CLP*RHP100552*1*269*87.81*22.4*HM*999031177061*11*1
823  NM1*QC*1*SYNTHETIC*PATIENT100552****MI*ZZ0100552
824  DTM*232*20260810
825  DTM*233*20260810
826  SVC*HC:99203*269*87.81**1
827  DTM*472*20260810
828  CAS*CO*45*157**253*1.79
829  CAS*PR*2*22.4
830  REF*6R*RHP100552-1
831  AMT*B6*112
832  LX*62
833  CLP*RHP100553*1*528*172.48*44*HM*999031177062*11*1
834  NM1*QC*1*SYNTHETIC*PATIENT100553****MI*ZZ0100553
835  DTM*232*20260809
836  DTM*233*20260809
837  SVC*HC:93306*528*172.48**1
838  DTM*472*20260809
839  CAS*CO*45*308**253*3.52
840  CAS*PR*2*44
841  REF*6R*RHP100553-1
842  AMT*B6*220
843  LX*63
844  CLP*RHP100554*1*449*146.61*37.4*HM*999031177063*11*1
845  NM1*QC*1*SYNTHETIC*PATIENT100554****MI*ZZ0100554
846  DTM*232*20260826
847  DTM*233*20260826
848  SVC*HC:99204*408*133.28**1
849  DTM*472*20260826
850  CAS*CO*45*238**253*2.72
851  CAS*PR*2*34
852  REF*6R*RHP100554-1
853  AMT*B6*170
854  SVC*HC:93000*41*13.33**1
855  DTM*472*20260826
856  CAS*CO*45*24**253*0.27
857  CAS*PR*2*3.4
858  REF*6R*RHP100554-2
859  AMT*B6*17
860  LX*64
861  CLP*RHP100555*1*2520*823.2*210*HM*999031177064*11*1
862  NM1*QC*1*SYNTHETIC*PATIENT100555****MI*ZZ0100555
863  DTM*232*20260825
864  DTM*233*20260825
865  SVC*HC:29827*2520*823.2**1
866  DTM*472*20260825
867  CAS*CO*45*1470**253*16.8
868  CAS*PR*2*210
869  REF*6R*RHP100555-1
870  AMT*B6*1050
871  LX*65
872  CLP*RHP100556*1*140*45.47*11.6*HM*999031177065*11*1
873  NM1*QC*1*SYNTHETIC*PATIENT100556****MI*ZZ0100556
874  DTM*232*20260824
875  DTM*233*20260824
876  SVC*HC:97110*140*45.47**2
877  DTM*472*20260824
878  CAS*CO*45*82**253*0.93
879  CAS*PR*2*11.6
880  REF*6R*RHP100556-1
881  AMT*B6*58
882  LX*66
883  CLP*RHP100557*1*576*188.16*48*HM*999031177066*11*1
884  NM1*QC*1*SYNTHETIC*PATIENT100557****MI*ZZ0100557
885  DTM*232*20260823
886  DTM*233*20260823
887  SVC*HC:64483*576*188.16**1
888  DTM*472*20260823
889  CAS*CO*45*336**253*3.84
890  CAS*PR*2*48
891  REF*6R*RHP100557-1
892  AMT*B6*240
893  LX*67
894  CLP*RHP100558*1*310*101.14*25.8*HM*999031177067*11*1
895  NM1*QC*1*SYNTHETIC*PATIENT100558****MI*ZZ0100558
896  DTM*232*20260822
897  DTM*233*20260822
898  SVC*HC:99213*221*72.13**1
899  DTM*472*20260822
900  CAS*CO*45*129**253*1.47
901  CAS*PR*2*18.4
902  REF*6R*RHP100558-1
903  AMT*B6*92
904  SVC*HC:90471*41*13.33**1
905  DTM*472*20260822
906  CAS*CO*45*24**253*0.27
907  CAS*PR*2*3.4
908  REF*6R*RHP100558-2
909  AMT*B6*17
910  SVC*HC:90686*48*15.68**1
911  DTM*472*20260822
912  CAS*CO*45*28**253*0.32
913  CAS*PR*2*4
914  REF*6R*RHP100558-3
915  AMT*B6*20
916  LX*68
917  CLP*RHP100559*1*338*110.54*28.2*HM*999031177068*11*1
918  NM1*QC*1*SYNTHETIC*PATIENT100559****MI*ZZ0100559
919  DTM*232*20260821
920  DTM*233*20260821
921  SVC*HC:99214*312*101.92**1
922  DTM*472*20260821
923  CAS*CO*45*182**253*2.08
924  CAS*PR*2*26
925  REF*6R*RHP100559-1
926  AMT*B6*130
927  SVC*HC:80053*26*8.62**1
928  DTM*472*20260821
929  CAS*CO*45*15**253*0.18
930  CAS*PR*2*2.2
931  REF*6R*RHP100559-2
932  AMT*B6*11
933  SE*931*0001
934  GE*1*105
935  IEA*1*000000105