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 B02M000056›HENRY REYES

HENRY REYES

Subscriber on policy B02M000056

Claims
1
Attributed to this person
Charged
555.00
Total submitted
Denied
555.00
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
NameHENRY REYES
Role on the policySubscriber
PolicyB02M000056
Date of birth9 Jul 1955
PlanSILVER HMO
Covered from4 Feb 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000026117 Jan 2026555.00MERIDIAN HEALTH PLANCARC 18 ยท DUPLICATE555.00