DenialIntel

Demo Environment โ€” Synthetic Data OnlyThis application contains synthetic demonstration data only. Do not enter or submit patient information (PHI) or other sensitive personal information.
Members›policy B04M000180›TOMAS VARGAS

TOMAS VARGAS

Subscriber on policy B04M000180

Claims
1
Attributed to this person
Charged
616.00
Total submitted
Denied
616.00
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 โ€” 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
NameTOMAS VARGAS
Role on the policySubscriber
PolicyB04M000180
Date of birth7 Mar 2002
PlanPLATINUM PPO
Covered from22 Apr 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000081426 Mar 2025616.00MERIDIAN HEALTH PLANCARC 27 ยท ELIGIBILITY616.00