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 B01M000176›VICTOR TANAKA

VICTOR TANAKA

Dependent on policy B01M000176

Claims
2
Attributed to this person
Charged
1,238.00
Total submitted
Denied
872.00
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 — 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
NameVICTOR TANAKA
Role on the policyDependent · relationship 19
PolicyB01M000176
Date of birth12 Feb 2012
PlanPLATINUM PPO
Covered from31 Oct 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00007514 Oct 2025366.00MERIDIAN HEALTH PLANNot denied—
CLM000075011 Jan 2025872.00MERIDIAN HEALTH PLANCARC 18 · DUPLICATE872.00