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 B02M000212›HENRY TANAKA

HENRY TANAKA

Subscriber on policy B02M000212

Claims
2
Attributed to this person
Charged
481.00
Total submitted
Denied
28.86
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
NameHENRY TANAKA
Role on the policySubscriber
PolicyB02M000212
Date of birth28 Dec 1971
PlanBRONZE EPO
Covered from20 Jun 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00009272 Oct 202582.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING28.86
CLM00009283 Aug 2024399.00MERIDIAN HEALTH PLANNot denied—