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 B10M000354›CARLA HUGHES

CARLA HUGHES

Dependent on policy B10M000354

Claims
3
Attributed to this person
Charged
1,141.00
Total submitted
Denied
1,014.75
3 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
NameCARLA HUGHES
Role on the policyDependent · relationship 19
PolicyB10M000354
Date of birth28 May 1985
PlanPLATINUM PPO
Covered from16 Sep 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000148212 Oct 2025369.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY369.00
CLM00014814 Dec 2024219.00MERIDIAN HEALTH PLANCARC 11 · CODING92.75
CLM000148327 Oct 2024553.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING553.00