X12 Ingest & Denial Analytics

Demo Environment โ€” Synthetic Data OnlyThis application contains synthetic demonstration data only. Do not enter or submit patient information (PHI) or other sensitive personal information.
Members›policy B08M000443›OMAR USMAN

OMAR USMAN

Subscriber on policy B08M000443

Claims
1
Attributed to this person
Charged
506.00
Total submitted
Denied
506.00
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 โ€” 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
NameOMAR USMAN
Role on the policySubscriber
PolicyB08M000443
Date of birth12 Mar 1968
PlanPLATINUM PPO
Covered from12 Aug 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000202929 Dec 2025506.00MERIDIAN HEALTH PLANCARC 29 ยท TIMELY_FILING506.00