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 B07M000230›GRACE PATEL

GRACE PATEL

Dependent on policy B07M000230

Claims
1
Attributed to this person
Charged
477.00
Total submitted
Denied
477.00
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
NameGRACE PATEL
Role on the policyDependent · relationship 01
PolicyB07M000230
Date of birth25 Oct 2008
PlanSILVER HMO
Covered from8 Feb 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000097426 Aug 2024477.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY477.00