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 B10M000120›TOMAS DIAZ

TOMAS DIAZ

Subscriber on policy B10M000120

Claims
2
Attributed to this person
Charged
840.00
Total submitted
Denied
0.00
0 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
NameTOMAS DIAZ
Role on the policySubscriber
PolicyB10M000120
Date of birth21 Jun 1953
PlanPLATINUM PPO
Covered from6 Apr 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000050126 Feb 2026227.00MERIDIAN HEALTH PLANNot denied—
CLM000050229 Oct 2025613.00MERIDIAN HEALTH PLANNot denied—