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 B02M000057›MARCUS SMITH

MARCUS SMITH

Subscriber on policy B02M000057

Claims
1
Attributed to this person
Charged
559.00
Total submitted
Denied
559.00
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
NameMARCUS SMITH
Role on the policySubscriber
PolicyB02M000057
Date of birth18 Dec 1997
PlanBRONZE EPO
Covered from17 Oct 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00002703 Feb 2026559.00MERIDIAN HEALTH PLANCARC 11 ยท CODING559.00