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 B03M000286›BRIAN OKAFOR

BRIAN OKAFOR

Dependent on policy B03M000286

Claims
1
Attributed to this person
Charged
335.00
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
NameBRIAN OKAFOR
Role on the policyDependent · relationship 19
PolicyB03M000286
Date of birth6 Nov 2015
PlanSILVER HMO
Covered from2 Jan 2025
Covered to22 Sep 2025

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00011342 May 2025335.00MERIDIAN HEALTH PLANNot denied—