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 B09M000423

Claims
3
Attributed to this person
Charged
1,648.00
Total submitted
Denied
822.00
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
NameZARA CHEN
Role on the policyDependent · relationship 19
PolicyB09M000423
Date of birth18 Oct 2013
PlanBRONZE EPO
Covered from23 Dec 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00017721 Mar 2026822.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY822.00
CLM00017713 Nov 202572.00MERIDIAN HEALTH PLANNot denied—
CLM00017706 Mar 2025754.00MERIDIAN HEALTH PLANNot denied—