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 B07M000186›OMAR JOHNSON

OMAR JOHNSON

Subscriber on policy B07M000186

Claims
3
Attributed to this person
Charged
1,831.00
Total submitted
Denied
1,224.00
2 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
NameOMAR JOHNSON
Role on the policySubscriber
PolicyB07M000186
Date of birth2 Sep 1957
PlanGOLD PPO
Covered from4 Feb 2025
Covered to16 Apr 2025

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000077113 Jun 2025773.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY773.00
CLM000077210 Jun 2025451.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY451.00
CLM000077321 Feb 2025607.00MERIDIAN HEALTH PLANNot denied—