X12 Ingest & Denial Analytics

Demo Environment โ€” Synthetic Data OnlyThis application contains synthetic demonstration data only. Do not enter or submit patient information (PHI) or other sensitive personal information.
Members›policy B03M000848›YUSUF YAMADA

YUSUF YAMADA

Subscriber on policy B03M000848

Claims
1
Attributed to this person
Charged
704.00
Total submitted
Denied
704.00
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 โ€” 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
NameYUSUF YAMADA
Role on the policySubscriber
PolicyB03M000848
Date of birth7 Oct 1993
PlanSILVER HMO
Covered from16 Jan 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000367526 Mar 2024704.00CASCADE CARECARC 109 ยท COB704.00