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 B09M000363›HENRY CHEN

HENRY CHEN

Dependent on policy B09M000363

Claims
2
Attributed to this person
Charged
1,180.00
Total submitted
Denied
154.89
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
NameHENRY CHEN
Role on the policyDependent · relationship 19
PolicyB09M000363
Date of birth15 Aug 2010
PlanBRONZE EPO
Covered from29 Jan 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000150228 Sep 2024766.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY154.89
CLM000150325 Sep 2024414.00MERIDIAN HEALTH PLANNot denied—