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 B01M000336›LEILA NGUYEN

LEILA NGUYEN

Subscriber on policy B01M000336

Claims
1
Attributed to this person
Charged
525.00
Total submitted
Denied
525.00
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
NameLEILA NGUYEN
Role on the policySubscriber
PolicyB01M000336
Date of birth10 May 1970
PlanBRONZE EPO
Covered from18 Apr 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000149111 Jun 2024525.00MERIDIAN HEALTH PLANCARC 27 ยท ELIGIBILITY525.00