X12 Ingest & Denial Analytics

Demo Environment โ€” Synthetic Data OnlyThis application contains synthetic demonstration data only. Do not enter or submit patient information (PHI) or other sensitive personal information.
Members›policy B09M000400›HENRY FOSTER

HENRY FOSTER

Subscriber on policy B09M000400

Claims
1
Attributed to this person
Charged
415.00
Total submitted
Denied
415.00
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 โ€” 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 FOSTER
Role on the policySubscriber
PolicyB09M000400
Date of birth28 Sep 1956
PlanGOLD PPO
Covered from15 Jan 2025
Covered to13 Jul 2025

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000165220 Aug 2025415.00MERIDIAN HEALTH PLANCARC 27 ยท ELIGIBILITY415.00