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 B09M000462›WENDY VARGAS

WENDY VARGAS

Dependent on policy B09M000462

Claims
2
Attributed to this person
Charged
340.00
Total submitted
Denied
340.00
2 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
NameWENDY VARGAS
Role on the policyDependent · relationship 19
PolicyB09M000462
Date of birth22 Mar 2017
PlanGOLD PPO
Covered from3 Feb 2024
Covered to31 Oct 2024

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000194813 Nov 202466.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY66.00
CLM00019471 Nov 2024274.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY274.00