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 B10M000133›DAVID NGUYEN

DAVID NGUYEN

Dependent on policy B10M000133

Claims
3
Attributed to this person
Charged
1,205.00
Total submitted
Denied
95.00
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
NameDAVID NGUYEN
Role on the policyDependent · relationship 01
PolicyB10M000133
Date of birth10 Mar 1980
PlanGOLD PPO
Covered from19 Nov 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000055331 Oct 2025452.00MERIDIAN HEALTH PLANNot denied—
CLM00005559 Jun 2025658.00MERIDIAN HEALTH PLANNot denied—
CLM000055428 Nov 202495.00MERIDIAN HEALTH PLANCARC 26 · ELIGIBILITY95.00