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 B03M000281›IVAN QUINN

IVAN QUINN

Subscriber on policy B03M000281

Claims
3
Attributed to this person
Charged
1,495.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
105.90
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
NameIVAN QUINN
Role on the policySubscriber
PolicyB03M000281
Date of birth16 Apr 1967
PlanBRONZE EPO
Covered from30 Sep 2024
Covered toopen

Patient responsibility reported on the 835

ReasonAdjustmentsAmount reported
CARC 1 · Deductible1105.90
Total105.90

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000112028 Jun 2026442.00MERIDIAN HEALTH PLANNot denied—
CLM000111922 Nov 2025706.00MERIDIAN HEALTH PLANNot denied—
CLM000111817 Sep 2025347.00MERIDIAN HEALTH PLANNot denied—