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 B10M000081›DAVID PATEL

DAVID PATEL

Subscriber on policy B10M000081

Claims
3
Attributed to this person
Charged
2,315.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
118.20
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
NameDAVID PATEL
Role on the policySubscriber
PolicyB10M000081
Date of birth17 Aug 1965
PlanSILVER HMO
Covered from20 Jun 2025
Covered toopen

Patient responsibility reported on the 835

ReasonAdjustmentsAmount reported
CARC 1 · Deductible1118.20
Total118.20

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000034122 Nov 2025788.00MERIDIAN HEALTH PLANNot denied—
CLM000034024 Sep 2025878.00MERIDIAN HEALTH PLANNot denied—
CLM000033912 Aug 2025649.00MERIDIAN HEALTH PLANNot denied—