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 B02M000150›NADIA LOPEZ

NADIA LOPEZ

Dependent on policy B02M000150

Claims
2
Attributed to this person
Charged
557.00
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
NameNADIA LOPEZ
Role on the policyDependent · relationship 01
PolicyB02M000150
Date of birth26 Sep 1996
PlanGOLD PPO
Covered from5 Jun 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00006854 Dec 2025307.00MERIDIAN HEALTH PLANNot denied—
CLM000068619 Sep 2025250.00MERIDIAN HEALTH PLANNot denied—