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 B03M000138›WENDY EVANS

WENDY EVANS

Dependent on policy B03M000138

Claims
2
Attributed to this person
Charged
1,254.00
Total submitted
Denied
682.00
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
NameWENDY EVANS
Role on the policyDependent · relationship 19
PolicyB03M000138
Date of birth18 Apr 2003
PlanBRONZE EPO
Covered from26 Sep 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000055928 Mar 2026572.00MERIDIAN HEALTH PLANNot denied—
CLM000056018 Feb 2026682.00MERIDIAN HEALTH PLANCARC 11 · CODING682.00