<?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>TPA002</ReceiverID>
    <TransactionDate>27/03/2024 12:51</TransactionDate>
    <RecordCount>2</RecordCount>
    <DispositionFlag>TEST</DispositionFlag>
  </Header>
  <Claim>
    <ID>TPA002_INS017_27_03_2024_24655_AP0092710</ID>
    <MemberID>34534</MemberID>
    <PayerID>INS017</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>784-1982-2724639-8</EmiratesIDNumber>
    <Gross>45.00</Gross>
    <PatientShare>2.5</PatientShare>
    <Net>42.50</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>AP0092710</PatientID>
      <Start>27/03/2024 00:00</Start>
      <End>27/03/2024 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>R50.2</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>27/03/2024 00:00</Start>
      <Type>3</Type>
      <Code>85025</Code>
      <Quantity>1.000</Quantity>
      <Net>20.00</Net>
      <Clinician>DHA-P-0240640</Clinician>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>27/03/2024 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>22.50</Net>
      <Clinician>DHA-P-0240640</Clinician>
    </Activity>
  </Claim>
  <Claim>
    <ID>TPA004_INS017_27_03_2024_24657_AP0203922</ID>
    <MemberID>62D3-5833-DAA1-D53E</MemberID>
    <PayerID>INS017</PayerID>
    <ProviderID>DHA-F-0045607</ProviderID>
    <EmiratesIDNumber>784-1979-9193542-6</EmiratesIDNumber>
    <Gross>140.00</Gross>
    <PatientShare>8.0</PatientShare>
    <Net>132.00</Net>
    <Encounter>
      <FacilityID>DHA-F-0045607</FacilityID>
      <Type>1</Type>
      <PatientID>AP0203922</PatientID>
      <Start>27/03/2024 00:00</Start>
      <End>27/03/2024 00:00</End>
      <StartType>1</StartType>
      <EndType>1</EndType>
    </Encounter>
    <Diagnosis>
      <Type>Principal</Type>
      <Code>A01.02</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>J00</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>S50.02XA</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>S50.02XD</Code>
    </Diagnosis>
    <Diagnosis>
      <Type>Secondary</Type>
      <Code>S50.02XS</Code>
    </Diagnosis>
    <Activity>
      <ID>1</ID>
      <Start>27/03/2024 00:00</Start>
      <Type>3</Type>
      <Code>20526</Code>
      <Quantity>1.000</Quantity>
      <Net>100.00</Net>
      <Clinician>DHA-P-0240640</Clinician>
    </Activity>
    <Activity>
      <ID>2</ID>
      <Start>27/03/2024 00:00</Start>
      <Type>8</Type>
      <Code>9</Code>
      <Quantity>1.000</Quantity>
      <Net>32.00</Net>
      <Clinician>DHA-P-0240640</Clinician>
    </Activity>
  </Claim>
</Claim.Submission>