X12 Ingest & Denial Analytics

Demo Environment โ€” Synthetic Data OnlyThis application contains synthetic demonstration data only. Do not enter or submit patient information (PHI) or other sensitive personal information.
Members›policy B10M000434›LEILA USMAN

LEILA USMAN

Subscriber on policy B10M000434

Claims
1
Attributed to this person
Charged
130.00
Total submitted
Denied
130.00
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 โ€” 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 USMAN
Role on the policySubscriber
PolicyB10M000434
Date of birth23 Oct 1969
PlanPLATINUM PPO
Covered from3 May 2025
Covered to25 Nov 2025

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000180323 Jul 2025130.00MERIDIAN HEALTH PLANCARC 29 ยท TIMELY_FILING130.00