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 B03M000011›CARLA CHEN

CARLA CHEN

Subscriber on policy B03M000011

Claims
3
Attributed to this person
Charged
1,461.00
Total submitted
Denied
1,336.00
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
NameCARLA CHEN
Role on the policySubscriber
PolicyB03M000011
Date of birth18 May 1971
PlanSILVER HMO
Covered from7 Jul 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000005512 May 2026445.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY445.00
CLM00000564 Apr 2025891.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY891.00
CLM000005726 Aug 2024125.00MERIDIAN HEALTH PLANNot denied—