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 B10M000276›LEILA OKAFOR

LEILA OKAFOR

Dependent on policy B10M000276

Claims
3
Attributed to this person
Charged
2,168.00
Total submitted
Denied
750.00
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
NameLEILA OKAFOR
Role on the policyDependent · relationship 19
PolicyB10M000276
Date of birth31 Mar 2012
PlanPLATINUM PPO
Covered from15 Mar 2025
Covered to11 Sep 2025

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000116420 Jul 2025750.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY750.00
CLM000116614 Jul 2025674.00MERIDIAN HEALTH PLANNot denied—
CLM000116522 Mar 2025744.00MERIDIAN HEALTH PLANNot denied—