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 B07M000201›BRIAN LOPEZ

BRIAN LOPEZ

Dependent on policy B07M000201

Claims
3
Attributed to this person
Charged
1,136.00
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
NameBRIAN LOPEZ
Role on the policyDependent · relationship 01
PolicyB07M000201
Date of birth16 Mar 1963
PlanBRONZE EPO
Covered from30 Nov 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000083910 Jul 2026737.00MERIDIAN HEALTH PLANNot denied—
CLM000083723 Sep 2025302.00MERIDIAN HEALTH PLANNot denied—
CLM000083816 Dec 202497.00MERIDIAN HEALTH PLANNot denied—