X12 Ingest & Denial Analytics

Demo Environment — Synthetic Data OnlyThis application contains synthetic demonstration data only. Do not enter or submit patient information (PHI) or other sensitive personal information.

ZARA CHEN

Subscriber on policy B01M000000

Claims
2
Attributed to this person
Charged
1,751.00
Total submitted
Denied
1,160.84
2 denied claims
Patient responsibility
0.00
Reported on the 835

Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.

Who this is

FieldValue
NameZARA CHEN
Role on the policySubscriber
PolicyB01M000000
Date of birth27 Jun 1986
PlanSILVER HMO
Covered from21 Jul 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000000127 Feb 2025874.00MERIDIAN HEALTH PLANCARC 16 · BILLING_ERROR283.84
CLM000000225 Aug 2024877.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY877.00