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 B07M000281›OMAR PATEL

OMAR PATEL

Subscriber on policy B07M000281

Claims
3
Attributed to this person
Charged
699.00
Total submitted
Denied
543.00
2 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 PATEL
Role on the policySubscriber
PolicyB07M000281
Date of birth14 Jul 1997
PlanPLATINUM PPO
Covered from9 Mar 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000121221 Feb 2026156.00NORTHSTAR MUTUALNot denied—
CLM000121331 Jul 2024367.00NORTHSTAR MUTUALCARC 96 · NON_COVERED367.00
CLM000121431 Mar 2024176.00NORTHSTAR MUTUALCARC 27 · ELIGIBILITY176.00