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 B04M000198›TOMAS ANDERSON

TOMAS ANDERSON

Dependent on policy B04M000198

Claims
3
Attributed to this person
Charged
2,087.00
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
NameTOMAS ANDERSON
Role on the policyDependent · relationship 19
PolicyB04M000198
Date of birth8 Nov 2010
PlanGOLD PPO
Covered from30 Sep 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00008896 Aug 2026468.00MERIDIAN HEALTH PLANNot denied—
CLM00008881 Mar 2026724.00MERIDIAN HEALTH PLANNot denied—
CLM000088713 Oct 2025895.00MERIDIAN HEALTH PLANNot denied—