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.

IVAN CHEN

Dependent on policy B03M000117

Claims
1
Attributed to this person
Charged
849.00
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
NameIVAN CHEN
Role on the policyDependent · relationship 01
PolicyB03M000117
Date of birth20 Aug 1970
PlanSILVER HMO
Covered from4 Oct 2024
Covered to23 Jun 2025

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000045810 Nov 2024849.00MERIDIAN HEALTH PLANNot denied—