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 B04M000187›HENRY WILSON

HENRY WILSON

Subscriber on policy B04M000187

Claims
1
Attributed to this person
Charged
660.00
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
NameHENRY WILSON
Role on the policySubscriber
PolicyB04M000187
Date of birth9 May 1957
PlanPLATINUM PPO
Covered from20 Sep 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000083615 Jan 2025660.00MERIDIAN HEALTH PLANNot denied—