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 B03M000247›DAVID IQBAL

DAVID IQBAL

Dependent on policy B03M000247

Claims
1
Attributed to this person
Charged
604.00
Total submitted
Denied
604.00
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
NameDAVID IQBAL
Role on the policyDependent · relationship 01
PolicyB03M000247
Date of birth28 Jun 1966
PlanBRONZE EPO
Covered from8 Jun 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000100320 Nov 2024604.00MERIDIAN HEALTH PLANCARC 18 · DUPLICATE604.00