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 B08M000209›TOMAS HUGHES

TOMAS HUGHES

Dependent on policy B08M000209

Claims
1
Attributed to this person
Charged
528.00
Total submitted
Denied
248.29
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
NameTOMAS HUGHES
Role on the policyDependent · relationship 01
PolicyB08M000209
Date of birth14 Nov 1983
PlanPLATINUM PPO
Covered from9 Dec 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000093420 Mar 2025528.00MERIDIAN HEALTH PLANCARC 16 · BILLING_ERROR248.29