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.

ZARA DIAZ

Dependent on policy B02M000017

Claims
1
Attributed to this person
Charged
740.00
Total submitted
Denied
0.00
0 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
NameZARA DIAZ
Role on the policyDependent · relationship 01
PolicyB02M000017
Date of birth19 Sep 1989
PlanGOLD PPO
Covered from8 May 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00000976 Dec 2024740.00MERIDIAN HEALTH PLANNot denied—