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 B03M000209›OMAR ANDERSON

OMAR ANDERSON

Dependent on policy B03M000209

Claims
3
Attributed to this person
Charged
1,176.00
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
NameOMAR ANDERSON
Role on the policyDependent · relationship 01
PolicyB03M000209
Date of birth28 Jun 2001
PlanSILVER HMO
Covered from23 Apr 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000086422 Mar 2026592.00MERIDIAN HEALTH PLANNot denied—
CLM000086218 Mar 2026369.00MERIDIAN HEALTH PLANNot denied—
CLM000086327 Aug 2025215.00MERIDIAN HEALTH PLANNot denied—