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 B07M000174›TOMAS FOSTER

TOMAS FOSTER

Subscriber on policy B07M000174

Claims
1
Attributed to this person
Charged
794.00
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
NameTOMAS FOSTER
Role on the policySubscriber
PolicyB07M000174
Date of birth3 Oct 1992
PlanGOLD PPO
Covered from3 Sep 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00007012 Nov 2024794.00MERIDIAN HEALTH PLANNot denied—