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.

OMAR CHEN

Dependent on policy B07M000226

Claims
3
Attributed to this person
Charged
1,055.00
Total submitted
Denied
142.92
1 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 CHEN
Role on the policyDependent · relationship 19
PolicyB07M000226
Date of birth17 Mar 2016
PlanBRONZE EPO
Covered from1 Mar 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00009558 Mar 2026593.00MERIDIAN HEALTH PLANNot denied—
CLM000095419 Feb 2026402.00MERIDIAN HEALTH PLANCARC 11 · CODING142.92
CLM000095310 Jun 202560.00MERIDIAN HEALTH PLANNot denied—