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 B02M000352›ZARA FOSTER

ZARA FOSTER

Dependent on policy B02M000352

Claims
2
Attributed to this person
Charged
1,013.00
Total submitted
Denied
580.59
2 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
NameZARA FOSTER
Role on the policyDependent · relationship 01
PolicyB02M000352
Date of birth18 Jul 1967
PlanSILVER HMO
Covered from8 Aug 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000150116 Feb 2026243.00MERIDIAN HEALTH PLANCARC 197 · AUTHORIZATION243.00
CLM000150014 Mar 2025770.00MERIDIAN HEALTH PLANCARC 16 · BILLING_ERROR337.59