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 B01M000420›HENRY DIAZ

HENRY DIAZ

Subscriber on policy B01M000420

Claims
1
Attributed to this person
Charged
353.00
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
NameHENRY DIAZ
Role on the policySubscriber
PolicyB01M000420
Date of birth6 Jul 1970
PlanGOLD PPO
Covered from7 Apr 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00018601 Jan 2026353.00MERIDIAN HEALTH PLANNot denied—