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 B09M000015›ELENA OKAFOR

ELENA OKAFOR

Subscriber on policy B09M000015

Claims
2
Attributed to this person
Charged
1,626.00
Total submitted
Denied
852.00
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
NameELENA OKAFOR
Role on the policySubscriber
PolicyB09M000015
Date of birth25 Sep 1960
PlanSILVER HMO
Covered from24 Oct 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000005716 Aug 2026852.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY852.00
CLM000005610 Aug 2026774.00MERIDIAN HEALTH PLANNot denied—