DenialIntel

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 B08M000536›IVAN BAKER

IVAN BAKER

Dependent on policy B08M000536

Claims
2
Attributed to this person
Charged
739.00
Total submitted
Denied
739.00
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
NameIVAN BAKER
Role on the policyDependent · relationship 19
PolicyB08M000536
Date of birth4 Nov 1987
PlanPLATINUM PPO
Covered from15 Apr 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00024503 Nov 2025264.00NORTHSTAR MUTUALCARC 27 · ELIGIBILITY264.00
CLM000245118 Sep 2024475.00NORTHSTAR MUTUALCARC 18 · DUPLICATE475.00