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 B03M000271›OMAR FOSTER

OMAR FOSTER

Subscriber on policy B03M000271

Claims
2
Attributed to this person
Charged
1,431.00
Total submitted
Denied
557.00
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
NameOMAR FOSTER
Role on the policySubscriber
PolicyB03M000271
Date of birth4 Sep 1989
PlanPLATINUM PPO
Covered from23 Aug 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00010867 Jan 2026874.00MERIDIAN HEALTH PLANNot denied—
CLM00010851 Sep 2024557.00MERIDIAN HEALTH PLANCARC 18 · DUPLICATE557.00