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.

RAVI DIAZ

Subscriber on policy B03M000466

Claims
1
Attributed to this person
Charged
64.00
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
NameRAVI DIAZ
Role on the policySubscriber
PolicyB03M000466
Date of birth31 May 1982
PlanPLATINUM PPO
Covered from2 Jun 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000193024 Mar 202664.00MERIDIAN HEALTH PLANNot denied—