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 B04M000331›AMARA YAMADA

AMARA YAMADA

Dependent on policy B04M000331

Claims
2
Attributed to this person
Charged
1,122.00
Total submitted
Denied
301.00
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
NameAMARA YAMADA
Role on the policyDependent · relationship 01
PolicyB04M000331
Date of birth29 Feb 1968
PlanBRONZE EPO
Covered from22 Aug 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000144418 Aug 2026821.00MERIDIAN HEALTH PLANNot denied—
CLM000144518 Apr 2026301.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY301.00