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

Dependent on policy B07M000174

Claims
3
Attributed to this person
Charged
786.00
Total submitted
Denied
481.00
1 denied claims
Patient responsibility
10.95
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 policyDependent · relationship 19
PolicyB07M000174
Date of birth13 Feb 2019
PlanGOLD PPO
Covered from3 Sep 2024
Covered toopen

Patient responsibility reported on the 835

ReasonAdjustmentsAmount reported
CARC 1 · Deductible110.95
Total10.95

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000070619 May 2026232.00MERIDIAN HEALTH PLANNot denied—
CLM000070519 Aug 2025481.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY481.00
CLM000070716 Nov 202473.00MERIDIAN HEALTH PLANNot denied—