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 B08M000048›ZARA EVANS

ZARA EVANS

Subscriber on policy B08M000048

Claims
1
Attributed to this person
Charged
78.00
Total submitted
Denied
0.00
0 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
NameZARA EVANS
Role on the policySubscriber
PolicyB08M000048
Date of birth25 Oct 1989
PlanBRONZE EPO
Covered from13 Jun 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000020128 Jul 202478.00MERIDIAN HEALTH PLANNot denied—