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 B08M000805›HENRY PATEL

HENRY PATEL

Subscriber on policy B08M000805

Claims
2
Attributed to this person
Charged
1,500.00
Total submitted
Denied
1,500.00
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
NameHENRY PATEL
Role on the policySubscriber
PolicyB08M000805
Date of birth14 Aug 1979
PlanGOLD PPO
Covered from26 Mar 2024
Covered to15 Dec 2024

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00035992 Apr 2024743.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING743.00
CLM000359823 Mar 2024757.00MERIDIAN HEALTH PLANCARC 26 · ELIGIBILITY757.00