<?xml version="1.0"?>
<Claim.Submission xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema">
  <Header>
    <SenderID>DHA-F-0045607</SenderID>
    <ReceiverID>TPA026</ReceiverID>
    <TransactionDate>15/08/2024 12:54</TransactionDate>
    <RecordCount>1</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>TPA026_INS017_15_08_2024_24698_OP-1875</ID>
    <MemberID>asd</MemberID>
    <PayerID>INS017</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>999-9999-9999999-9</EmiratesIDNumber>
    <Gross>14.00</Gross>
    <PatientShare>0.000</PatientShare>
    <Net>14.00</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>OP-1875</PatientID>
      <Start>05/07/2024 00:00</Start>
      <End>05/07/2024 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>A00.0</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>R50.2</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>05/07/2024 00:00</Start>
      <Type>3</Type>
      <Code>85027</Code>
      <Quantity>1.000</Quantity>
      <Net>14.00</Net>
      <Clinician>DHA-P-0240256</Clinician>
    </Activity>
  </Claim>
</Claim.Submission>