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 B07M000398›HENRY NGUYEN

HENRY NGUYEN

Dependent on policy B07M000398

Claims
2
Attributed to this person
Charged
785.00
Total submitted
Denied
38.91
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
NameHENRY NGUYEN
Role on the policyDependent · relationship 01
PolicyB07M000398
Date of birth30 Mar 1953
PlanSILVER HMO
Covered from3 Mar 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000169512 Oct 2025656.00MERIDIAN HEALTH PLANNot denied—
CLM000169628 Sep 2025129.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY38.91