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 B03M000446›VICTOR ANDERSON

VICTOR ANDERSON

Subscriber on policy B03M000446

Claims
2
Attributed to this person
Charged
1,151.00
Total submitted
Denied
580.00
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
NameVICTOR ANDERSON
Role on the policySubscriber
PolicyB03M000446
Date of birth27 Sep 1975
PlanGOLD PPO
Covered from12 Apr 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000184229 Apr 2026580.00MERIDIAN HEALTH PLANCARC 18 · DUPLICATE580.00
CLM00018412 Jan 2026571.00MERIDIAN HEALTH PLANNot denied—