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 B02M000001›CARLA FOSTER

CARLA FOSTER

Dependent on policy B02M000001

Claims
2
Attributed to this person
Charged
887.00
Total submitted
Denied
272.04
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
NameCARLA FOSTER
Role on the policyDependent · relationship 01
PolicyB02M000001
Date of birth29 Nov 1980
PlanPLATINUM PPO
Covered from12 May 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00000124 Aug 2025331.00MERIDIAN HEALTH PLANNot denied—
CLM000001114 Nov 2024556.00MERIDIAN HEALTH PLANCARC 26 · ELIGIBILITY272.04