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 B04M000150›FIONA BAKER

FIONA BAKER

Dependent on policy B04M000150

Claims
1
Attributed to this person
Charged
132.00
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
NameFIONA BAKER
Role on the policyDependent · relationship 01
PolicyB04M000150
Date of birth17 Mar 1963
PlanBRONZE EPO
Covered from3 Jun 2024
Covered to12 Oct 2024

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00006898 Jun 2024132.00MERIDIAN HEALTH PLANNot denied—