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 B08M000108›FIONA CHEN

FIONA CHEN

Dependent on policy B08M000108

Claims
3
Attributed to this person
Charged
2,243.00
Total submitted
Denied
1,150.05
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
NameFIONA CHEN
Role on the policyDependent · relationship 01
PolicyB08M000108
Date of birth22 May 1975
PlanGOLD PPO
Covered from21 Aug 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000047216 Aug 2026682.00MERIDIAN HEALTH PLANNot denied—
CLM00004715 Aug 2025751.00MERIDIAN HEALTH PLANCARC 11 · CODING340.05
CLM000047021 Oct 2024810.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING810.00