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 B07M000070›MARCUS LOPEZ

MARCUS LOPEZ

Dependent on policy B07M000070

Claims
2
Attributed to this person
Charged
842.00
Total submitted
Denied
0.00
0 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
NameMARCUS LOPEZ
Role on the policyDependent · relationship 01
PolicyB07M000070
Date of birth31 Jul 1971
PlanBRONZE EPO
Covered from17 Apr 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000029721 Feb 2026163.00MERIDIAN HEALTH PLANNot denied—
CLM000029829 May 2025679.00MERIDIAN HEALTH PLANNot denied—