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 B08M000272›TOMAS PATEL

TOMAS PATEL

Dependent on policy B08M000272

Claims
1
Attributed to this person
Charged
619.00
Total submitted
Denied
619.00
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
NameTOMAS PATEL
Role on the policyDependent · relationship 19
PolicyB08M000272
Date of birth24 Jul 2006
PlanGOLD PPO
Covered from28 Jul 2024
Covered to9 Mar 2025

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000123823 Dec 2024619.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING619.00