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 B04M000009›KEVIN YAMADA

KEVIN YAMADA

Dependent on policy B04M000009

Claims
2
Attributed to this person
Charged
812.00
Total submitted
Denied
313.00
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
NameKEVIN YAMADA
Role on the policyDependent · relationship 19
PolicyB04M000009
Date of birth27 Sep 2000
PlanSILVER HMO
Covered from20 Sep 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00000496 Dec 2025313.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING313.00
CLM000005010 Jun 2025499.00MERIDIAN HEALTH PLANNot denied—