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 B03M000205›VICTOR TANAKA

VICTOR TANAKA

Subscriber on policy B03M000205

Claims
1
Attributed to this person
Charged
419.00
Total submitted
Denied
419.00
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
NameVICTOR TANAKA
Role on the policySubscriber
PolicyB03M000205
Date of birth20 Feb 2003
PlanPLATINUM PPO
Covered from20 Mar 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000084627 Feb 2024419.00MERIDIAN HEALTH PLANCARC 26 ยท ELIGIBILITY419.00