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 B09M000182›IVAN BAKER

IVAN BAKER

Dependent on policy B09M000182

Claims
3
Attributed to this person
Charged
1,227.00
Total submitted
Denied
662.00
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
NameIVAN BAKER
Role on the policyDependent · relationship 01
PolicyB09M000182
Date of birth25 Nov 1964
PlanGOLD PPO
Covered from15 Jun 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000076815 Dec 2025463.00MERIDIAN HEALTH PLANNot denied—
CLM000076918 Nov 2025102.00MERIDIAN HEALTH PLANNot denied—
CLM000076719 Aug 2025662.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY662.00