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 B03M000416›LEILA CHEN

LEILA CHEN

Dependent on policy B03M000416

Claims
1
Attributed to this person
Charged
261.00
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
NameLEILA CHEN
Role on the policyDependent · relationship 19
PolicyB03M000416
Date of birth22 Oct 2021
PlanSILVER HMO
Covered from31 Oct 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00016965 Jun 2025261.00MERIDIAN HEALTH PLANNot denied—