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 B07M000100›ELENA GARCIA

ELENA GARCIA

Dependent on policy B07M000100

Claims
2
Attributed to this person
Charged
1,201.00
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
NameELENA GARCIA
Role on the policyDependent · relationship 19
PolicyB07M000100
Date of birth6 Apr 2007
PlanPLATINUM PPO
Covered from28 Feb 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00004123 Jul 2026774.00MERIDIAN HEALTH PLANNot denied—
CLM000041318 Nov 2025427.00MERIDIAN HEALTH PLANNot denied—