X12 Ingest & Denial Analytics

Demo Environment โ€” Synthetic Data OnlyThis application contains synthetic demonstration data only. Do not enter or submit patient information (PHI) or other sensitive personal information.
Members›policy B07M000408›DAVID NGUYEN

DAVID NGUYEN

Subscriber on policy B07M000408

Claims
1
Attributed to this person
Charged
534.00
Total submitted
Denied
534.00
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 โ€” 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
NameDAVID NGUYEN
Role on the policySubscriber
PolicyB07M000408
Date of birth22 May 1950
PlanBRONZE EPO
Covered from25 Aug 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000172528 Sep 2025534.00MERIDIAN HEALTH PLANCARC 29 ยท TIMELY_FILING534.00