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 B04M000025›ZARA HUGHES

ZARA HUGHES

Dependent on policy B04M000025

Claims
2
Attributed to this person
Charged
627.00
Total submitted
Denied
107.00
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
NameZARA HUGHES
Role on the policyDependent · relationship 01
PolicyB04M000025
Date of birth21 Aug 1982
PlanGOLD PPO
Covered from19 Mar 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000010713 Dec 2025107.00MERIDIAN HEALTH PLANCARC 11 · CODING107.00
CLM00001084 Nov 2025520.00MERIDIAN HEALTH PLANNot denied—