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 B07M000307›JULIA CHEN

JULIA CHEN

Dependent on policy B07M000307

Claims
2
Attributed to this person
Charged
1,637.00
Total submitted
Denied
323.73
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
NameJULIA CHEN
Role on the policyDependent · relationship 19
PolicyB07M000307
Date of birth16 Dec 1983
PlanSILVER HMO
Covered from4 Jan 2024
Covered to30 Jun 2024

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000132624 Feb 2024747.00NORTHSTAR MUTUALNot denied—
CLM000132510 Jan 2024890.00NORTHSTAR MUTUALCARC 50 · MEDICAL_NECESSITY323.73