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 B01M000154›ZARA REYES

ZARA REYES

Dependent on policy B01M000154

Claims
3
Attributed to this person
Charged
1,028.00
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 policyDependent · relationship 01
PolicyB01M000154
Date of birth22 Jan 1952
PlanBRONZE EPO
Covered from29 Sep 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00006516 Mar 202683.00MERIDIAN HEALTH PLANNot denied—
CLM000065010 Oct 2025824.00MERIDIAN HEALTH PLANNot denied—
CLM000064926 Jan 2025121.00MERIDIAN HEALTH PLANNot denied—