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 B04M000024›HENRY OKAFOR

HENRY OKAFOR

Dependent on policy B04M000024

Claims
2
Attributed to this person
Charged
1,250.00
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 OKAFOR
Role on the policyDependent · relationship 01
PolicyB04M000024
Date of birth26 Nov 2006
PlanBRONZE EPO
Covered from1 Feb 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00001043 Sep 2025426.00MERIDIAN HEALTH PLANNot denied—
CLM00001034 Aug 2025824.00MERIDIAN HEALTH PLANNot denied—