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.

UMA REYES

Subscriber on policy B08M000092

Claims
2
Attributed to this person
Charged
1,085.00
Total submitted
Denied
1,085.00
2 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
NameUMA REYES
Role on the policySubscriber
PolicyB08M000092
Date of birth26 Aug 1970
PlanGOLD PPO
Covered from20 Mar 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000040613 Aug 2026417.00MERIDIAN HEALTH PLANCARC 96 · NON_COVERED417.00
CLM000040727 Aug 2025668.00MERIDIAN HEALTH PLANCARC 18 · DUPLICATE668.00