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.

ZARA CHEN

Dependent on policy B09M000370

Claims
2
Attributed to this person
Charged
1,166.00
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
NameZARA CHEN
Role on the policyDependent · relationship 01
PolicyB09M000370
Date of birth31 Jan 1960
PlanBRONZE EPO
Covered from22 Jul 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00015268 Jun 2025877.00MERIDIAN HEALTH PLANNot denied—
CLM000152514 Aug 2024289.00MERIDIAN HEALTH PLANNot denied—