<?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>Docmate</SenderID>
    <ReceiverID>TPA004</ReceiverID>
    <TransactionDate>10/10/2024 11:18</TransactionDate>
    <RecordCount>1</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>TPA004_INS012_10_10_2024_24757_AP0203922</ID>
    <MemberID>62D3-5833-DAA1-D51E</MemberID>
    <PayerID>INS012</PayerID>
    <ProviderID>Docmate</ProviderID>
    <EmiratesIDNumber>784-1979-9193542-7</EmiratesIDNumber>
    <Gross>54.00</Gross>
    <PatientShare>5.400</PatientShare>
    <Net>48.60</Net>
    <Encounter>
      <FacilityID>Docmate</FacilityID>
      <Type>1</Type>
      <PatientID>AP0203922</PatientID>
      <Start>10/10/2024 00:00</Start>
      <End>10/10/2024 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>M54.5</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>10/10/2024 00:00</Start>
      <Type>3</Type>
      <Code>97010</Code>
      <Quantity>1.000</Quantity>
      <Net>24.30</Net>
      <Clinician>DHa-P-1122334</Clinician>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>10/10/2024 00:00</Start>
      <Type>3</Type>
      <Code>97010</Code>
      <Quantity>1.000</Quantity>
      <Net>24.30</Net>
      <Clinician>DHa-P-1122334</Clinician>
    </Activity>
  </Claim>
</Claim.Submission>