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 B10M000056›VICTOR KUMAR

VICTOR KUMAR

Dependent on policy B10M000056

Claims
2
Attributed to this person
Charged
729.00
Total submitted
Denied
619.00
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
NameVICTOR KUMAR
Role on the policyDependent · relationship 01
PolicyB10M000056
Date of birth26 Sep 1951
PlanSILVER HMO
Covered from2 Mar 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000022225 Feb 2026110.00NORTHSTAR MUTUALNot denied—
CLM000022314 Jul 2024619.00NORTHSTAR MUTUALCARC 11 · CODING619.00