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 B09M000046›GRACE JOHNSON

GRACE JOHNSON

Dependent on policy B09M000046

Claims
1
Attributed to this person
Charged
489.00
Total submitted
Denied
0.00
0 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
NameGRACE JOHNSON
Role on the policyDependent · relationship 19
PolicyB09M000046
Date of birth18 Mar 2008
PlanSILVER HMO
Covered from18 Jun 2025
Covered to3 Mar 2026

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00002119 Nov 2025489.00MERIDIAN HEALTH PLANNot denied—