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 B04M000176›ELENA TANAKA

ELENA TANAKA

Subscriber on policy B04M000176

Claims
2
Attributed to this person
Charged
466.00
Total submitted
Denied
356.00
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
NameELENA TANAKA
Role on the policySubscriber
PolicyB04M000176
Date of birth12 Sep 1950
PlanSILVER HMO
Covered from8 Nov 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00008011 Aug 2025110.00MERIDIAN HEALTH PLANNot denied—
CLM000080012 Oct 2024356.00MERIDIAN HEALTH PLANCARC 26 · ELIGIBILITY356.00