DenialIntel

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 B02M000391›DAVID PATEL

DAVID PATEL

Dependent on policy B02M000391

Claims
2
Attributed to this person
Charged
984.00
Total submitted
Denied
508.00
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 — 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
NameDAVID PATEL
Role on the policyDependent · relationship 01
PolicyB02M000391
Date of birth5 Feb 1999
PlanSILVER HMO
Covered from16 May 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000166628 Oct 2025476.00NORTHSTAR MUTUALNot denied—
CLM000166716 Apr 2025508.00NORTHSTAR MUTUALCARC 26 · ELIGIBILITY508.00