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 B10M000337›BRIAN REYES

BRIAN REYES

Dependent on policy B10M000337

Claims
3
Attributed to this person
Charged
1,042.00
Total submitted
Denied
490.00
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
NameBRIAN REYES
Role on the policyDependent · relationship 01
PolicyB10M000337
Date of birth15 Sep 1997
PlanPLATINUM PPO
Covered from4 Mar 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000140925 Oct 2025232.00MERIDIAN HEALTH PLANCARC 197 · AUTHORIZATION232.00
CLM000140820 Aug 2025552.00MERIDIAN HEALTH PLANNot denied—
CLM00014103 Jun 2024258.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING258.00