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 B08M000067›IVAN IQBAL

IVAN IQBAL

Dependent on policy B08M000067

Claims
2
Attributed to this person
Charged
607.00
Total submitted
Denied
529.00
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
NameIVAN IQBAL
Role on the policyDependent · relationship 19
PolicyB08M000067
Date of birth21 Nov 2008
PlanGOLD PPO
Covered from9 Aug 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00003051 Jul 202578.00MERIDIAN HEALTH PLANNot denied—
CLM000030622 Nov 2024529.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING529.00