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.

OMAR CHEN

Subscriber on policy B04M000112

Claims
3
Attributed to this person
Charged
2,060.00
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
NameOMAR CHEN
Role on the policySubscriber
PolicyB04M000112
Date of birth21 Nov 1971
PlanSILVER HMO
Covered from24 Mar 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000051425 Nov 2025693.00MERIDIAN HEALTH PLANNot denied—
CLM00005165 Nov 2025676.00MERIDIAN HEALTH PLANNot denied—
CLM000051514 Mar 2025691.00MERIDIAN HEALTH PLANNot denied—