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 B10M000047›GRACE OKAFOR

GRACE OKAFOR

Subscriber on policy B10M000047

Claims
2
Attributed to this person
Charged
1,350.00
Total submitted
Denied
1,350.00
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
NameGRACE OKAFOR
Role on the policySubscriber
PolicyB10M000047
Date of birth6 Jan 1985
PlanPLATINUM PPO
Covered from15 Oct 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00001784 Jun 2025696.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING696.00
CLM000017719 Feb 2025654.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING654.00