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.
Members›policy B07M000000›BRIAN YAMADA

BRIAN YAMADA

Subscriber on policy B07M000000

Claims
2
Attributed to this person
Charged
500.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
73.00
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
NameBRIAN YAMADA
Role on the policySubscriber
PolicyB07M000000
Date of birth18 Sep 1996
PlanSILVER HMO
Covered from27 Jun 2024
Covered toopen

Patient responsibility reported on the 835

ReasonAdjustmentsAmount reported
CARC 2 · Coinsurance173.00
Total73.00

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000000211 Jan 2026135.00MERIDIAN HEALTH PLANNot denied—
CLM000000117 May 2025365.00MERIDIAN HEALTH PLANNot denied—