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 B02M000048›GRACE QUINN

GRACE QUINN

Subscriber on policy B02M000048

Claims
2
Attributed to this person
Charged
606.00
Total submitted
Denied
61.00
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
NameGRACE QUINN
Role on the policySubscriber
PolicyB02M000048
Date of birth3 Jul 1967
PlanBRONZE EPO
Covered from11 May 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00002301 May 202661.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY61.00
CLM000023125 Nov 2025545.00MERIDIAN HEALTH PLANNot denied—