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 B03M000432›HENRY EVANS

HENRY EVANS

Subscriber on policy B03M000432

Claims
2
Attributed to this person
Charged
553.00
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
NameHENRY EVANS
Role on the policySubscriber
PolicyB03M000432
Date of birth1 Jul 1997
PlanBRONZE EPO
Covered from23 Jan 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00017601 Oct 2025178.00MERIDIAN HEALTH PLANNot denied—
CLM00017591 Jul 2025375.00MERIDIAN HEALTH PLANNot denied—