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 B09M000455›ZARA NGUYEN

ZARA NGUYEN

Subscriber on policy B09M000455

Claims
2
Attributed to this person
Charged
776.00
Total submitted
Denied
118.00
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 NGUYEN
Role on the policySubscriber
PolicyB09M000455
Date of birth11 May 1983
PlanPLATINUM PPO
Covered from24 Oct 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000191313 Oct 2025658.00MERIDIAN HEALTH PLANNot denied—
CLM000191218 Jun 2025118.00MERIDIAN HEALTH PLANCARC 197 · AUTHORIZATION118.00