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 B04M000175›BRIAN KUMAR

BRIAN KUMAR

Subscriber on policy B04M000175

Claims
2
Attributed to this person
Charged
1,119.00
Total submitted
Denied
254.74
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
NameBRIAN KUMAR
Role on the policySubscriber
PolicyB04M000175
Date of birth5 Feb 1999
PlanGOLD PPO
Covered from11 Feb 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000079728 Jul 2026458.00MERIDIAN HEALTH PLANNot denied—
CLM000079811 Dec 2025661.00MERIDIAN HEALTH PLANCARC 16 · BILLING_ERROR254.74