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 B01M000378›BRIAN LOPEZ

BRIAN LOPEZ

Subscriber on policy B01M000378

Claims
2
Attributed to this person
Charged
741.00
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
NameBRIAN LOPEZ
Role on the policySubscriber
PolicyB01M000378
Date of birth11 Feb 1982
PlanBRONZE EPO
Covered from17 Feb 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000167212 Apr 2026442.00MERIDIAN HEALTH PLANNot denied—
CLM000167325 Apr 2025299.00MERIDIAN HEALTH PLANNot denied—