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 B03M000425›CARLA BAKER

CARLA BAKER

Subscriber on policy B03M000425

Claims
2
Attributed to this person
Charged
1,086.00
Total submitted
Denied
610.00
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
NameCARLA BAKER
Role on the policySubscriber
PolicyB03M000425
Date of birth5 Oct 1956
PlanBRONZE EPO
Covered from2 Oct 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000173111 Feb 2026610.00MERIDIAN HEALTH PLANCARC 26 · ELIGIBILITY610.00
CLM000173222 Apr 2025476.00MERIDIAN HEALTH PLANNot denied—