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 B10M000162›KEVIN REYES

KEVIN REYES

Dependent on policy B10M000162

Claims
2
Attributed to this person
Charged
1,650.00
Total submitted
Denied
1,650.00
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
NameKEVIN REYES
Role on the policyDependent · relationship 01
PolicyB10M000162
Date of birth18 Mar 1970
PlanPLATINUM PPO
Covered from28 Jan 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00006741 Feb 2025890.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY890.00
CLM00006755 Jan 2025760.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY760.00