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 B08M000043›YUSUF EVANS

YUSUF EVANS

Subscriber on policy B08M000043

Claims
1
Attributed to this person
Charged
758.00
Total submitted
Denied
758.00
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
NameYUSUF EVANS
Role on the policySubscriber
PolicyB08M000043
Date of birth1 Jan 1977
PlanBRONZE EPO
Covered from22 Dec 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000017822 Aug 2025758.00MERIDIAN HEALTH PLANCARC 29 ยท TIMELY_FILING758.00