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 B08M000005›FIONA PATEL

FIONA PATEL

Dependent on policy B08M000005

Claims
1
Attributed to this person
Charged
462.00
Total submitted
Denied
221.83
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
NameFIONA PATEL
Role on the policyDependent · relationship 01
PolicyB08M000005
Date of birth23 Aug 1965
PlanBRONZE EPO
Covered from27 May 2024
Covered to4 Sep 2024

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000002722 Jul 2024462.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY221.83