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.

UMA CHEN

Dependent on policy B03M000357

Claims
3
Attributed to this person
Charged
1,210.00
Total submitted
Denied
520.00
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
NameUMA CHEN
Role on the policyDependent · relationship 01
PolicyB03M000357
Date of birth9 Apr 1990
PlanSILVER HMO
Covered from14 Jan 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000143329 Dec 2025111.00MERIDIAN HEALTH PLANNot denied—
CLM000143426 Aug 2025520.00MERIDIAN HEALTH PLANCARC 18 · DUPLICATE520.00
CLM000143515 Jan 2025579.00MERIDIAN HEALTH PLANNot denied—