QCQC*87654321*12345678*003*DENY*EP772TMPAY29        *0513300080593020*05052802295*M *00                            *                              *20051007*20051004*AE12345N   *DOE              *JANE      *Z*0000*20051001*20051002*           *2232*       1.000*      987.61*        0.00*0000*00696*PROV ON CLAIM NOT RECIPIENT PCP PROV                                                      *     *                                                                                          *                                        *          *          *                                                  ~QCQC*87654321*12345678*003*PAID*EP772TMPAY29        *0529000000013620*05103100125*M *00                            *                              *20051017*20051004*AH99999R   *SMITH            *JANA      *L*0000*20051001*20051002*           *2207*       1.000*      987.61*      259.41*0000*     *                                                                                          *     *                                                                                          *                                        *          *          *                                                  ~