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 B07M000210›ZARA REYES

ZARA REYES

Subscriber on policy B07M000210

Claims
1
Attributed to this person
Charged
543.00
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
NameZARA REYES
Role on the policySubscriber
PolicyB07M000210
Date of birth21 Dec 1959
PlanBRONZE EPO
Covered from6 Apr 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000088023 Apr 2024543.00MERIDIAN HEALTH PLANNot denied—