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 B04M000145›WENDY ANDERSON

WENDY ANDERSON

Subscriber on policy B04M000145

Claims
3
Attributed to this person
Charged
1,826.00
Total submitted
Denied
1,826.00
3 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
NameWENDY ANDERSON
Role on the policySubscriber
PolicyB04M000145
Date of birth31 Mar 2000
PlanGOLD PPO
Covered from10 Jun 2025
Covered to21 Sep 2025

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000066510 Oct 2025838.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY838.00
CLM00006642 Oct 2025579.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY579.00
CLM00006666 Jun 2025409.00MERIDIAN HEALTH PLANCARC 26 · ELIGIBILITY409.00