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 B03M000032›TOMAS TANAKA

TOMAS TANAKA

Subscriber on policy B03M000032

Claims
1
Attributed to this person
Charged
357.00
Total submitted
Denied
357.00
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
NameTOMAS TANAKA
Role on the policySubscriber
PolicyB03M000032
Date of birth14 Mar 1956
PlanGOLD PPO
Covered from8 Apr 2025
Covered to11 Dec 2025

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00001455 May 2025357.00MERIDIAN HEALTH PLANCARC 27 ยท ELIGIBILITY357.00