DenialIntel

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 B10M000182›TOMAS YAMADA

TOMAS YAMADA

Subscriber on policy B10M000182

Claims
3
Attributed to this person
Charged
1,601.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
559.00
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 YAMADA
Role on the policySubscriber
PolicyB10M000182
Date of birth12 Nov 1979
PlanSILVER HMO
Covered from7 Jan 2024
Covered toopen

Patient responsibility reported on the 835

ReasonAdjustmentsAmount reported
CARC 50 · Other1559.00
Total559.00

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000074810 May 2026364.00MERIDIAN HEALTH PLANNot denied—
CLM000075019 Dec 2024377.00MERIDIAN HEALTH PLANNot denied—
CLM00007491 Nov 2024860.00MERIDIAN HEALTH PLANCARC 50 · MEDICAL_NECESSITY0.00